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A serendipitous finding during development of an automated “electronic flow chart” system to gather data on ICU patients [1] was the observation of low frequency oscillations in blood pressure that were not explained by systematic variability in the environment. [2] This finding has since been confirmed by others. [3,4] In the present report, hemodynamic data for critically ill surgical patients was continuously collected and visualized on a computer workstation to search for patterns not noted by standard monitoring. With this system, we observed low-frequency periodic oscillations in the cardiac output of ten patients, with regular periodicities of 4 to 280 minutes (average = 34 minutes). The mortality rate in these patients was 40%, while the mortality was only 10.8% in 83 similarly monitored intensive care unit (ICU) patients who did not develop regular oscillations in cardiac output. Interestingly, these oscillatory patterns appear to be associated with inadequate resuscitation of increased metabolic rates. The mathematical definition of “chaos” refers to irregular behavior that appears to be random but is actually deterministic. [5] A surprising finding concerning transitions between states of apparent randomness and order in nonlinear systems is that many systems become more organized after being disturbed. Chaotic behavior in biological systems may represent a normal physiologic state, while the loss of chaotic behavior may herald a pathophysiologic state. [6] The mechanism of the regular low frequency oscillations in cardiac output remains to be determined, but the high mortality rate suggests that it is a pathophysiologic marker, perhaps due to inadequate oxygen delivery in under-resuscitated shock. © 1997 John Wiley & Sons, Inc.

Regular low frequency cardiac output oscillations observed in critically ill surgical patients