Usefulness of bioelectrical impedance analysis and ECW ratio as a guidance for fluid management in critically ill patients after operation

Abstract

We determined the relationship between changes in bioelectrical impedance analysis (BIA) parameters and response of critically ill patients to fluid therapy during early postoperative period. Associations between BIA values indicating volume status of postoperative patient and clinical outcomes were also evaluated. From May 2019 to April 2020, patients who were admitted to the surgical intensive care unit (SICU) of our institution at more than 48 h after surgery were enrolled. Volume status was measured with a portable BIA device every morning for five days from SICU admission. Overhydration was defined as the case where extracellular water (ECW) ratio > 0.390 measured by BIA. Participants were daily classified into an overhydration or a normohydration group. The relationship between daily hydration status and postoperative outcome was evaluated. Most of the 190 participants showed the overhydration status in the first 48 h after surgery. The overhydration status on day 3 was significant predictor of postoperative morbidities (OR 1.182) and in-hospital mortality (OR 2.040). SOFA score was significant factor of postoperative morbidities (OR 1.163) and in-hospital mortality (OR 3.151) except for the overhydration status on day 3. Cut-off values of overhydration status by ECW ratio at day 3 for predicting postoperative morbidities and in-hospital mortality were > 0.3985 and > 0.4145, respectively. BIA would be a useful and convenient tool to assess the volume status of patients requiring intensive fluid resuscitation in early postoperative period. Overhydration status by ECW ratio on postoperative day 3 needs careful monitoring and appropriate interventions to improve clinical outcomes.

The Possibility of Using Bioelectrical Impedance Analysis in Pregnant and Postpartum Women

“…75% of PE patients had excessive GWG [14]. The Da Silva study showed that TBW and ECW were higher in the group of women with PE, while in both absolute and relative terms the percentage of ICW was lower in this group [66,69].…”

“…The BIA method measures impedance, i.e., resistance value, caused by the h of intense exercise. The BIA method measures impedance, i.e., resistance value, caused by the difference in electrical conductivity of each type of biological tissue, e.g., fat or muscles [14]. The four-compartment model of body composition consists of the fat mass (FM) and the lean mass (FFM), which are further divided into the total body water (TBW), proteins and minerals (Figure 1) [15].…”

“…The devices can operate using a single frequency of 50 kHz or multi-frequency (from 5 to 1000 The electrical conductivity is proportional to the amount of water or electrolytes, which allows BIA to quantify intracellular (ICW) and extracellular water (ECW) as well as the fat and muscle mass. This method is used to assess body composition [12,14]. The devices can operate using a single frequency of 50 kHz or multi-frequency (from 5 to 1000 kHz) body composition analysis [18,19].…”

Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

“…The current methods used to evaluate uid status have limitations. Chung et al's [23] study showed that BIA and ECW/TBW ratios are useful and convenient tools used to assess the volume status of patients. According to the result of previous studies, the cut-off value for the assessment of edema was 0.39 [24][25][26].…”

“…Slobod et al's [27] study also showed that a higher ECW/TBW ratio within 24 h of admission was correlated with a longer duration of MV. Therefore, the ECW/TBW ratio can be a good prognostic factor for diseases or as a guide for uid management in critically ill patients [28,29]. BIA has intrinsic limitations in its ability to accurately distinguish between intravascular and interstitial volume in the extracellular compartment.…”