Complex systems and the technology of variability analysis

Characteristic patterns of variation over time, namely rhythms, represent a defining feature of complex systems, one that is synonymous with life. Despite the intrinsic dynamic, interdependent and nonlinear relationships of their parts, complex biological systems exhibit robust systemic stability. Applied to critical care, it is the systemic properties of the host response to a physiological insult that manifest as health or illness and determine outcome in our patients. Variability analysis provides a novel technology with which to evaluate the overall properties of a complex system. This review highlights the means by which we scientifically measure variation, including analyses of overall variation (time domain analysis, frequency distribution, spectral power), frequency contribution (spectral analysis), scale invariant (fractal) behaviour (detrended fluctuation and power law analysis) and regularity (approximate and multiscale entropy). Each technique is presented with a definition, interpretation, clinical application, advantages, limitations and summary of its calculation. The ubiquitous association between altered variability and illness is highlighted, followed by an analysis of how variability analysis may significantly improve prognostication of severity of illness and guide therapeutic intervention in critically ill patients

Dynamics and complexity of body temperature in preterm infants nursed in incubators

Poor control of body temperature is associated with mortality and major morbidity in preterm infants. We aimed to quantify its dynamics and complexity to evaluate whether indices from fluctuation analyses of temperature time series obtained within the first five days of life are associated with gestational age (GA) and body size at birth, and presence and severity of typical comorbidities of preterm birth.; We recorded 3h-time series of body temperature using a skin electrode in incubator-nursed preterm infants. We calculated mean and coefficient of variation of body temperature, scaling exponent alpha (Talpha) derived from detrended fluctuation analysis, and sample entropy (TSampEn) of temperature fluctuations. Data were analysed by multilevel multivariable linear regression.; Data of satisfactory technical quality were obtained from 285/357 measurements (80%) in 73/90 infants (81%) with a mean (range) GA of 30.1 (24.0-34.0) weeks. We found a positive association of Talpha with increasing levels of respiratory support after adjusting for GA and birth weight z-score (p<0.001; R2 = 0.38).; Dynamics and complexity of body temperature in incubator-nursed preterm infants show considerable associations with GA and respiratory morbidity. Talpha may be a useful marker of autonomic maturity and severity of disease in preterm infants

Cardiorespiratory Function in Young Adults With a History of Covid-19 Infection

Objective. Respiratory complications may persist several months into the recovery period following COVID-19 infection. This study evaluated respiratory function and oxygen saturation variability between young adults with a history of COVID-19 infection and controls. Associations between cardiorespiratory function with potential biobehavioral correlates of COVID-19 infection were also explored.Methods. 57 adults ages 18 to 65 participated in this study (24 COVID+, 33 Control). Spirometry was used to assess pulmonary function volumes of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC and peak expiratory flow (PEF). Exhaled nitric oxide (FeNO) was measured using the NiOX VERO, a handheld electrochemical nitric oxide analyzer and taken as a proxy of airway inflammation. Systemic inflammation levels were assessed using salivary concentrations of inflammatory biomarkers. Oxygen saturation variability was quantified via extended continuous oxygen saturation (SpO2) monitoring using linear and nonlinear analyses. Network physiology analysis was conducted to evaluate cardiorespiratory control between SpO2, heart rate (HR), respiratory rate and skin temperature signals measured by continuous ambulatory monitoring with an Equivital EQO2 LifeMonitor. Physical activity levels and sedentary time were assessed using 9-day accelerometry. COVID-19 symptom severity was assessed by participant self-report via questionnaires. Results. No group differences were observed for pulmonary function of FVC (COVID+: 4.22±1.01, C: 4.43±1.06 L, p=.663), FEV1 (COVID+: 3.45±0.72, C: 3.57±0.92 L, p=.865), PEF (COVID+: 349.63±105.54, C: 373.73±140.61 L/min, p=.370), or FeNO (COVID+: 16.61±13.04, C: 20.03±20.11 ppb, p=.285). Linear and nonlinear oxygen saturation variability did not differ between adults with a history of COVID-19 infection and controls with no history of infection (p\u3e0.05). Cardiorespiratory function measured using network analysis of did not differ between recovering COVID-19 individuals and controls (p\u3e0.05). Sedentary time was inversely associated with FEV1 (r=-.392, p=.040), PEF (r=-.579, p=.003), and IL-6 concentrations (r=- .370, p=.049). COVID-19 disease severity was inversely associated with FVC (r=-.461, p=.012) and FEV1 (r=-.365, p=.040). Number of symptoms was inversely associated with FVC (r=-.404, p=.025). Conclusions. Pulmonary function, inflammation levels and oxygen saturation variability were similar between individuals with a history of COVID-19 infection and controls without a history of COVID-19 infection. Network interactions between regulatory components of the cardiorespiratory system were also similar between recovering COVID-19 individuals and controls. Findings suggest that cardiorespiratory function and dynamic control of SpO2 may not be impaired following COVID-19 infection in young adults. Moreover, increased sedentary time and disease severity may have negative effects on pulmonary function in individuals recovering from COVID-19