Bio-electrical impedance analysis in critically ill patients: are we ready for prime time?

Myatchin, Ivan; Abraham, Paul A.; Malbrain, Manu L N G

doi:10.1007/s10877-019-00439-0

Cited by 17 publications

(14 citation statements)

References 32 publications

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“…Lastly, some other techniques like bioelectrical impedance analysis could also have been used to detect if the change in weight could be attributed due to fluid accumulation alone. 25 …”

Section: Discussionmentioning

confidence: 99%

Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients

Mishra¹,

Pande²

2021

Indian Journal of Critical Care Medicine

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A bstract Background Intravenous fluid optimization is an essential component of managing patients in a critical care setting. A cumulative positive fluid balance is consistent with poor outcomes in patients admitted to the intensive care unit (ICU). The overall utility of net cumulative fluid balance as a surrogate for assessing fluid overload has been interrogated. Materials and methods This study was a prospective single-center observational study, which was done to correlate body weight changes with fluid balance in ICU patients and evaluate its impact on clinical outcomes. Inclusion criteria consisted of adult patients who were admitted to the critical care unit on specialized beds with integrated weighing scales between September 2017 and December 2018. The evaluation of the effect of changes in body weight on ICU survival was the primary objective of the study. Results We enrolled 105 patients in this study. The ICU mortality was 23.80% with non-survivors showing more weight gain than the survivors. Statistically significant weight gain was documented in the non-survivors on days 3 and 4 (1.9 vs 1.05; p = 0.0084 and 2.6 vs 1.6; p = 0.0030) of ICU admission. Non-survivors had greater cumulative positive fluid balance on fourth, fifth, and sixth days post-ICU admission when compared to survivors (3586 vs 1659 mL, p = 0.0322; 5418 vs 1255 mL, p = 0.0017; and 5430 vs 2305 mL p = 0.0264, respectively). In multivariate regression analysis, cumulative fluid balance did not correlate with days on mechanical ventilation or length of stay in ICU. Changes in body weight and cumulative fluid balance showed a good correlation. Conclusion In patients admitted to the ICU, weight gain on third and fourth days of admission is concordant with increased ICU mortality. Body weight changes were seen to correlate well with the cumulative fluid balance. How to cite this article Mishra RK, Pande A, Ramachandran R, Trikha A, Singh PM, Rewari V. Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients. Indian J Crit Care Med 2021;25(9):1042–1048.

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“…Lastly, some other techniques like bioelectrical impedance analysis could also have been used to detect if the change in weight could be attributed due to fluid accumulation alone. 25 …”

Section: Discussionmentioning

confidence: 99%

Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients

Mishra¹,

Pande²

2021

Indian Journal of Critical Care Medicine

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“…For an in-depth evaluation of fluid homeostasis, bioelectrical impedance (BIA) measurements were performed daily. For BIA, the Nutriguard-MS system was used (Data Input GmbH, Poecking, Germany) [ 26 – 28 ]. Measurement was conducted in a hand-to-foot approach with the patient strictly supine and free from measurement confounders.…”

Section: Methodsmentioning

confidence: 99%

Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection

Wollborn

Hassenzahl

Reker

et al. 2021

Ann. Intensive Care

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Background The concomitant occurrence of the symptoms intravascular hypovolemia, peripheral edema and hemodynamic instability is typically named Capillary Leak Syndrome (CLS) and often occurs in surgical critical ill patients. However, neither a unitary definition nor standardized diagnostic criteria exist so far. We aimed to investigate common characteristics of this phenomenon with a subsequent scoring system, determining whether CLS contributes to mortality. Methods We conducted this single-center, observational, multidisciplinary, prospective trial in two separately run surgical ICUs of a tertiary academic medical center. 200 surgical patients admitted to the ICU and 30 healthy volunteers were included. Patients were clinically diagnosed as CLS or No-CLS group (each N = 100) according to the grade of edema, intravascular hypovolemia, hemodynamic instability, and positive fluid balance by two independent attending physicians with > 10 years of experience in ICU. We performed daily measurements with non-invasive body impedance electrical analysis, ultrasound and analysis of serum biomarkers to generate objective diagnostic criteria. Receiver operating characteristics were used, while we developed machine learning models to increase diagnostic specifications for our scoring model. Results The 30-day mortility was increased among CLS patients (12 vs. 1%, P = 0.002), while showing higher SOFA-scores. Extracellular water was increased in patients with CLS with higher echogenicity of subcutaneous tissue [29(24–31) vs. 19(16–21), P < 0.001]. Biomarkers showed characteristic alterations, especially with an increased angiopoietin-2 concentration in CLS [9.9(6.2–17.3) vs. 3.7(2.6–5.6)ng/mL, P < 0.001]. We developed a score using seven parameters (echogenicity, SOFA-score, angiopoietin-2, syndecan-1, ICAM-1, lactate and interleukin-6). A Random Forest prediction model boosted its diagnostic characteristics (AUC 0.963, P < 0.001), while a two-parameter decision tree model showed good specifications (AUC 0.865). Conclusions Diagnosis of CLS in critically ill patients is feasible by objective, non-invasive parameters using the CLS-Score. A simplified two-parameter diagnostic approach can enhance clinical utility. CLS contributes to mortality and should, therefore, classified as an independent entity. Trial Registration: German Clinical Trials Registry (DRKS No. 00012713), Date of registration 10/05/2017, www.drks.de Graphical Abstract

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“…On the basis of the assumption that excess volume accumulates primarily as ECW, the quantity of overhydration can be calculated as the difference between expected ECW, based on the euvolemic ECW/TBW ratio, and the measured ECW [ 28 , 29 ]. On ICU days 1 and 3, BIS-OH (>1l) associated significantly with hospital mortality in 140 ICU patients with 23 nonsurvivors.…”

Section: Outcome Prediction With Bioelectric Impedance Analysismentioning

confidence: 99%

Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness

Moonen

Zanten

2021

Current Opinion in Critical Care

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Purpose of review Insight into body composition is of great value in the ICU. Bioelectric impedance analysis (BIA) is the most applicable bedside technique. However, bioimpedance has not been validated in the critically ill, and the interpretation of the measurements poses challenges. This review discusses the potential clinical applications of BIA and explores caveats and solutions to its use in the intensive care setting. Recent findings A correlation is repeatedly found between raw impedance parameters, fluid ratios, overhydration, and adverse outcome of critical illness. However, cut-off and reference values remain elusive. Experience with BIA-guided fluid management in the ICU is limited. BIA-derived muscle mass appears a promising biomarker for sarcopenia, correlating well with CT-analysis. Body cell mass and fat-free mass provide potential use in estimation of metabolic rate, protein requirements and pharmacokinetics. Several methods of reducing bias in BIA parameters in critical illness require validation. Summary There are currently too many uncertainties and discrepancies regarding interpretation of bioimpedance in critical illness, to justify therapeutic consequences. However, there are several promising areas of research, concerning some of the most urgent clinical problems in intensive care, emphasizing the need to evaluate further the use and interpretation of bioimpedance in the intensive care setting.

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Bio-electrical impedance analysis in critically ill patients: are we ready for prime time?

Cited by 17 publications

References 32 publications

Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients

Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients

Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection

Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness

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