Estimation of Body Fluid Status by Fluid Balance and Body Weight in Critically Ill Adult Patients: A Systematic Review

Davies, Hugh; Leslie, Gavin; Jacob, Élisabeth; Morgan, David

doi:10.1111/wvn.12394

Cited by 22 publications

(26 citation statements)

References 18 publications

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“…To overcome these fallacies, alternative techniques like daily body weight measurement and total body plethysmography have been suggested to assess fluid balance. 11 Commercially available electronic beds can be used for daily assessment of patient's weight, which has been used to measure fluid balance with varying results. 12 , 13 Body weight changes in ICU patients are attributed to a myriad of factors like nature of illness, fluid balance, and nutritional status.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Thirst intensity, assessed using the category and visual analog scales, was used to evaluate the subjective sensation of the fluid status of healthy individuals in daily life [ 27 , 28 ]. According to Davies et al [ 29 ], changes in body weight can be used to estimate body fluid status in ill patients. However, total body weight is not suitable for monitoring the dynamic body fluid status [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status

Chen

Lee

et al. 2021

JPM

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The evaluation of fluid status can save adults from life-threatening conditions, but the current methods are invasive or time-consuming. Therefore, we developed a portable device for measuring salivary conductivity. This prospective observational study enrolled 20 volunteers with no history of systemic diseases. Participants were observed for 13 h, including water restriction for 12 h followed by rehydration with 1000 mL water within 1 h. Serum and urine biomarkers for fluid status, thirst scales, and salivary conductivity were collected during dehydration and rehydration. No significant differences in age, body mass index, glycohemoglobin, and estimated glomerular filtration rate were noted between sexes. Salivary conductivity increased after water restriction and decreased after rehydration. Similarly, urine osmolality, urine specific gravity, thirst intensity scales, and body weight followed the same trend and were statistically significant. The angiotensin-converting enzyme and aldosterone levels showed the same trend, without reaching statistical significance. The red blood cell count and hemoglobin concentration also followed the same trend. Analyzing the receiver operating characteristic curves, the area under the curve was 0.707 (95% confidence interval 0.542–0.873, p = 0.025). Using the Youden index, the optimal cutoff determined as 2678.09 μs/cm (sensitivity: 90%, specificity: 55%). This biodevice effectively screened dehydration among healthy adults.

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“…Nursing staff were trained on how to operate bed systems. Inaccuracies in both fluid balance and body weight estimations can be assumed to have occurred due to pragmatic nursing constraints amplified by highly imprecise indiscernible fluid losses formulas [9,11,12,14]. There are speculations about an attenuated influence of fluid accumulation over body weight in critically ill patients who are hospitalized for longer than five days, since muscle and fat loss as well as bone demineralization must play a major role after such a period [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Despite its widespread utilization, the allegedly simple method of subtracting fluid output from the patient’s input requires the recording of multiple infusions of fluid such as nutrition, blood products and intravenous medications, as well as hourly urinary output and loss of other body fluids, such as fluid lost from surgical drains. As a result, the process of charting fluid balance is very time-consuming and subject to calculation errors [ 9 ], which tend to build up when it comes to cumulative fluid balance [ 10 ]. Moreover, accounting for indiscernible water loss or diarrhoea is also inaccurate [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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The Correspondence between Fluid Balance and Body Weight Change Measurements in Critically Ill Adult Patients

Antônio

Fernandes

Azzolin

2021

The Journal of Critical Care Medicine

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Introduction Positive fluid status has been associated with a worse prognosis in intensive care unit (ICU) patients. Given the potential for errors in the calculation of fluid balance totals and the problem of accounting for indiscernible fluid losses, measurement of body weight change is an alternative non-invasive method commonly used for estimating body fluid status. The objective of the study is to compare the measurements of fluid balance and body weight changes over time and to assess their association with ICU mortality. Methods This prospective observational study was conducted in the 34-bed multidisciplinary ICU of a tertiary teaching hospital in southern Brazil. Adult patients were eligible if their expected length of stay was more than 48 hours, and if they were not receiving an oral diet. Clinical demographic data, daily and cumulative fluid balance with and without indiscernible water loss, and daily and total body weight changes were recorded. Agreement between daily fluid balance and body weight change, and between cumulative fluid balance and total body weight change were calculated. Results Cumulative fluid balance and total body weight change differed significantly among survivors and non survivors respectively, +2.53L versus +5.6L (p= 0.012) and -3.05kg vs -1.1kg (p= 0.008). The average daily difference between measured fluid balance and body weight was +0.864 L/kg with a wide interval: -3.156 to +4.885 L/kg, which remained so even after adjustment for indiscernible losses (mean bias: +0.288; limits of agreement between -3.876 and +4.452 L/kg). Areas under ROC curve for cumulative fluid balance, cumulative fluid balance with indiscernible losses and total body weight change were, respectively, 0.65, 0.56 and 0.65 (p= 0.14). Conclusion The results indicated the absence of correspondence between fluid balance and body weight change, with a more significant discrepancy between cumulative fluid balance and total body weight change. Both fluid balance and body weight changes were significantly different among survivors and non-survivors, but neither measurement discriminated ICU mortality.

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Estimation of Body Fluid Status by Fluid Balance and Body Weight in Critically Ill Adult Patients: A Systematic Review

Cited by 22 publications

References 18 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

A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status

The Correspondence between Fluid Balance and Body Weight Change Measurements in Critically Ill Adult Patients

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