Bioimpedance-measured volume overload predicts longer duration of mechanical ventilation in intensive care unit patients

Slobod, Douglas; Yao, Han; Mardini, Joëlle; Natkaniec, Justyna; Correa, José A.; Jayaraman, Dev; Weber, Catherine

doi:10.1007/s12630-019-01450-4

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…ECW/TBW-ratio is higher among ICU nonsurvivors and correlates with a longer mechanical ventilation duration [ 25 ]. Slobod et al found that a SF-BIA ECW/TBW-ratio greater than 0.39 on ICU-day 1, associated with an increased number of ventilation days, independent of the APACHE-II score [ 26 ▪ ]. In CRRT ICU patients, a cut-off for SMMF-BIA ECW/TBW-ratio of 0.413 predicted 28-day mortality, with 71.4% sensitivity and 70.6% specificity [ 27 ].…”

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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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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“…BIA was applied to measure fluids, but instead of validating the instrument through reference testing, the pursuit was to apply BIA as a prognostic tool validated against patient-centered outcomes such as time in need for mechanical ventilation and mortality. 38,43,[45][46][47] Others sought to validate BIA through correlations with ICU severity scores. 48…”

Section: Summary Of Evidencementioning

confidence: 99%

Bioimpedance as a measure of fluid status in critically ill patients: A systematic review

Madsen

Wichmann

Bestle

et al. 2021

Acta Anaesthesiol Scand

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Objective Precise measurements of fluid status lack valid methods. Bioimpedance is an attractive diagnostic tool because it is noninvasive, quick, and relatively cheap. This systematic review aims to assess the existing evidence of bioimpedance as an accurate measure of fluid status in critically ill patients. Data sources PubMed and Embase up till March 2021 were systematically searched (PROSPERO: CRD42020157436). Study selection Eligibility criteria were studies reporting original data from cohorts of adult patients in intensive care units and doing at least one whole‐body bioimpedance and one reference test. In addition, studies assessing internal reproducibility were included. Data extraction An extraction form was designed for the purpose. Data synthesis Nine hundred five studies were screened for eligibility, and 28 studies, comprising 1482 individual patients, were included in the final analysis. Eight studies compared bioimpedance with a gold standard, and two of those reported the results adequate. We found a low mean difference, but the 95% limits of agreements had wide limits. The remaining studies applied different surrogates as reference tests. Correlations ranged from 0.05 to 0.99. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence for all outcomes was very low. Conclusions The accuracy of bioimpedance as a measure for fluids in critically ill patients in the intensive care unit cannot be determined. Due to the lack of a gold standard, numerous studies compared bioimpedance with surrogate outcomes with great variability in both designs and results. Assessing the internal reproducibility of bioimpedance had the same limitations, but the studies overall reported good internal reproducibility.

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“…D. Slobod and co-authors evaluated the hydration of ICU patients according to ECW/TBW ratio and investigated the effect of volume status on the duration of mechanical ventilation, 28 day mortality and AKI requiring RRT. No association between ECW/TBW ratio at day 1 and day 28 was found, but it was revealed that bioimpedance-measured ECW/TBW ratio on day 1 of admission to the ICU was associated with time on the ventilator ( p = 0.05) [ 12 ]. In our study, we also found that higher proportion of hyperhydrated patients suffered from MOF and were on APV compared to hypohydrated/normohydrated patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury

et al. 2021

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Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.

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Bioimpedance-measured volume overload predicts longer duration of mechanical ventilation in intensive care unit patients

Cited by 13 publications

References 19 publications

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

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

Bioimpedance as a measure of fluid status in critically ill patients: A systematic review

Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury

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