1
|
Peng J, Yang J, Li F. Association of bioimpedance analysis parameters trajectories with clinical outcomes in neurocritical patients. Heliyon 2024; 10:e32948. [PMID: 38994111 PMCID: PMC11238003 DOI: 10.1016/j.heliyon.2024.e32948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
Background and objective Neurocritical patients often experience uncontrolled high catabolic metabolism state during the acuta phase of the disease. The complex interactions of neuroendocrine, inflammation, and immune system lead to massive protein breakdown and changes in body composition. Bioelectrical impedance analysis (BIA) evaluates the content and proportions of body components based on the principles of bioelectricity. Its parameters reflect the overall health status of the body and the integrity of cellular structure and function, playing an important role in assessing the disease status and predicting prognosis of such patients. This study explored the association of BIA parameters trajectories with clinical outcomes in neurocritical patients. Methods This study prospectively collected BIA parameters of 127 neurocritical patients in the Department of Neurology admitted to the NICU for the first 1-7 days. All these patients were adults (≥18 years old) experiencing their first onset of illness and were in the acute phase of the disease. The group-based trajectory modeling (GBTM), which aims to identify individuals following similar developmental trajectories, was used to identify potential subgroups of individuals based on BIA parameters. The short-term prognosis of patients in each trajectory group with variations in phase angle (PA) and extracellular water/total body water (ECW/TBW) over time was differentially analyzed, and the logistic regression model was used to analyze the relationship between potential trajectory groups of PA and ECW/TBW and the short-term prognosis of neurocritical patients. The outcome was Glasgow Outcome Scale (GOS) score at discharge. Results Four PA trajectories and four ECW/TBW trajectories were detected respectively in neurocritical patients. Among them, compared with the other latent subgroups, the "Low PA rapidly decreasing subgroup" and the "High ECW/TBW slowly rising subgroup" had higher incidences of adverse outcomes at discharge (GOS:1-3), in-hospital mortality, and length of neurology intensive care unit stay (all P < 0.05). After correcting for potential confounders, compared with the "Low PA rapidly decreasing subgroup", the risk of adverse outcome (GOS:1-3) was lower in the other three PA trajectories, with OR values of 0.0003, 0.0004, and 0.003 respectively (all P < 0.05). Compared with the "High ECW/TBW slowly rising subgroup", the risk of adverse outcome (GOS:1-3) was lower in the other three ECW/TBW trajectories, with OR values of 0.013, 0.035 and 0.038 respectively (all P < 0.05). Conclusion Latent PA trajectories and latent ECW/TBW trajectories during 1-7 days after admission were associated with the clinical outcomes of neurocritical patients. The risk of adverse outcomes was highest in the "Low PA rapidly decreasing subgroup" and the "High ECW/TBW slowly rising subgroup". These results reflected the overall health status and nutritional condition of neurocritical patients at the onset of the disease, and demonstrated the dynamic change process in body composition caused by the inflammatory response during the acute phase of the disease. This provided a reference basis for the observation and prognostic evaluation of such patients.
Collapse
Affiliation(s)
- Jingjing Peng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jiajia Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| |
Collapse
|
2
|
Rodríguez-Moguel N, Osuna-Padilla IA, Piekarska KB, Negrete-García MF, Hernández-Muñoz A, Contreras-Marín JA, Montaño-Mattar R, Casas-Aparicio G. Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study. J Clin Med 2024; 13:540. [PMID: 38256674 PMCID: PMC10816646 DOI: 10.3390/jcm13020540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.
Collapse
Affiliation(s)
- Nadia Rodríguez-Moguel
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico;
| | - Ivan Armando Osuna-Padilla
- Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico;
| | - Karolina Bozena Piekarska
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - María-Fernanda Negrete-García
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - Andrea Hernández-Muñoz
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
| | - Julián Andrés Contreras-Marín
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - Roberto Montaño-Mattar
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
- Departamento de Nefrología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Gustavo Casas-Aparicio
- Departamento de Nefrología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| |
Collapse
|
3
|
Cleymaet R, D’Hondt M, Scheinok T, Malbrain L, De Laet I, Schoonheydt K, Dits H, Van Regenmortel N, Mekeirele M, Cordemans C, Minini A, Severgnini P, Dabrowski W, Wong A, Malbrain MLNG. Comparison of Bioelectrical Impedance Analysis (BIA)-Derived Parameters in Healthy Volunteers and Critically Ill Patients. Life (Basel) 2023; 14:27. [PMID: 38255643 PMCID: PMC10821189 DOI: 10.3390/life14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To compare bioelectrical impedance analysis (BIA)-derived parameters in healthy volunteers and critically ill patients and to assess its prognostic value in an ICU patient cohort. DESIGN Retrospective, observational data analysis. SETTING Single centre, tertiary-level ICU (Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg Hospital). PATIENTS 101 patients and 101 healthy subjects, participants of International Fluid Academy Days. MEASUREMENTS AND MAIN RESULTS Compared to healthy volunteers, both male and female ICU patients had significantly higher values for total body water (TBW), extracellular water (ECW), extracellular fluid (ECF), plasma, and interstitial fluid volumes. The phase angle was significantly lower and the malnutrition index was significantly higher in ICU patients, regardless of gender. Non-survivors in the ICU had significantly higher extracellular water content (ECW, 50.7 ± 5.1 vs. 48.9 ± 4.3%, p = 0.047) and accordingly significantly lower intracellular water (ICW, 49.2 ± 5.1 vs. 51.1 ± 4.3%, p = 0.047). The malnutrition index was also significantly higher in non-survivors compared to survivors (0.94 ± 0.17 vs. 0.87 ± 0.16, p = 0.048), as was the capillary leak index (ECW/ICW). CONCLUSIONS Compared to healthy volunteers, this study observed a higher malnutrition index and TBW in ICU patients with an accumulation of fluids in the extracellular compartment. ICU non-survivors showed similar results, indicating that ICU patients and a fortiori non-survivors are generally overhydrated, with increased TBW and ECW, and more undernourished, as indicated by a higher malnutrition index.
Collapse
Affiliation(s)
- Robbert Cleymaet
- Department of Oromaxillofacial and Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marvin D’Hondt
- Department of Oromaxillofacial and Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Thomas Scheinok
- Department of Neurology, University Hospital Brussels (UZB), 1090 Jette, Belgium
| | - Luca Malbrain
- University School of Medicine, Katholieke Universiteit Leuven (KUL), 3000 Leuven, Belgium
| | - Inneke De Laet
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Karen Schoonheydt
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Hilde Dits
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Niels Van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Michael Mekeirele
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Jette, Belgium
| | - Colin Cordemans
- Department of Intensive Care, AZ Sint-Maria Hospital, 1500 Halle, Belgium;
| | - Andrea Minini
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090 Jette, Belgium
- School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, 21100 Varese, Italy;
| | - Paolo Severgnini
- School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, 21100 Varese, Italy;
- Department of Anestesia e Rianimazione Cardiologica, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, 20-954 Lublin, Poland
| | - Adrian Wong
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Jette, Belgium
- Department of Intensive Care Medicine and Anaesthesia, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, 20-954 Lublin, Poland
- International Fluid Academy, 3360 Lovenjoel, Belgium
- Medaman, Medical Data Management, 2440 Geel, Belgium
| |
Collapse
|
4
|
Koch EB, Madsen JM, Wichmann S, Bestle MH, Itenov TS. Bioimpedance and Duration of Organ Dysfunction in Septic Shock-A Prospective Observational Study. J Intensive Care Med 2023; 38:966-974. [PMID: 37186782 DOI: 10.1177/08850666231175819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Rationale: Bioimpedance may be a useful tool to guide fluid treatment and avoid organ dysfunction related to fluid overload. Objective: We examined the correlation between bioimpedance and organ dysfunction in patients with septic shock. Methods: Prospective observational study of adult intensive care unit patients fulfilling the sepsis-3 criteria. Bioimpedance was measured using a body composition monitor (BCM) and BioScan Touch i8 (MBS). We measured impedance at inclusion and after 24 h and reported the impedance, change in impedance, bioimpedance-derived fluid balance, and changes in bioimpedance-derived fluid balance. Organ markers on respiratory, circulatory, and kidney function and overall disease severity were ascertained on days 1-7. The effect of bioimpedance on the change in organ function was assessed by mixed effects linear models. We considered P < .01 as significant. Measurements and Main Results: Forty-nine patients were included. None of the single baseline measurements or derived fluid balances were associated with the course of organ dysfunction. Changes in impedance were associated with the course of overall disease severity (P < .001; with MBS), and with changes in noradrenaline dose (P < .001; with MBS) and fluid balance (P < .001; with BCM). The changes in bioimpedance-derived fluid balance were associated with changes in noradrenaline dose (P < .001; with BCM), cumulative fluid balances (P < .001; with MBS), and lactate concentrations (P < .001; with BCM). Conclusions: Changes in bioimpedance were correlated with the duration of overall organ failure, circulatory failure, and fluid status. Single measurements of bioimpedance were not associated with any changes in organ dysfunction.
Collapse
Affiliation(s)
- Ellen Bjerre Koch
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Janne M Madsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theis S Itenov
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Cowart C, Roberts SM. Pro: Modified Ultrafiltration Is Beneficial for Adults Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:1049-1052. [PMID: 36754730 DOI: 10.1053/j.jvca.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Christopher Cowart
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA
| | - S Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA.
| |
Collapse
|
6
|
Bawua LK, Miaskowski C, Suba S, Badilini F, Rodway GW, Hu X, Pelter MM. Thoracic Impedance Pneumography-Derived Respiratory Alarms and Associated Patient Characteristics. Am J Crit Care 2022; 31:355-365. [PMID: 36045046 DOI: 10.4037/ajcc2022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm types and associated patient characteristics, which could guide alarm management strategies. OBJECTIVES To characterize RR alarms by type, frequency, duration, and associated patient demographic and clinical characteristics. METHODS A secondary data analysis of alarms generated with impedance pneumography in 461 adult patients admitted to either a cardiac, a medical/surgical, or a neurological intensive care unit (ICU). The RR alarms included high parameter limit (≥30 breaths/min), low parameter limit (≤5 breaths/min), and apnea (no breathing ≥20 s). The ICU type; total time monitored; and alarm type, frequency, and duration were evaluated. RESULTS Of 159 771 RR alarms, parameter limit alarms (n = 140 975; 88.2%) were more frequent than apnea alarms (n = 18 796; 11.8%). High parameter limit alarms were most frequent (n = 131 827; 82.5%). After ICU monitoring time was controlled for, multivariate analysis showed that alarm rates were higher in patients in the cardiac and neurological ICUs (P = .001), patients undergoing mechanical ventilation (P = .005), and patients without a ventricular assist device or pacemaker (P = .02). Male sex was associated with low parameter limit (P = .01) and apnea (P = .005) alarms. CONCLUSION High parameter limit RR alarms were most frequent. Factors associated with RR alarms included monitoring time, ICU type, male sex, and mechanical ventilation. Although these factors are not modifiable, these data could be used to guide management strategies.
Collapse
Affiliation(s)
- Linda K Bawua
- Linda K. Bawua is a former PhD student, School of Nursing, University of California, San Francisco, California
| | - Christine Miaskowski
- Christine Miaskowski is a professor, School of Nursing, University of California, San Francisco, California
| | - Sukardi Suba
- Sukardi Suba is a postdoctoral associate, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Fabio Badilini
- Fabio Badilini is director of the Center for Physiological Research, School of Nursing, University of California, San Francisco, California
| | - George W Rodway
- George W. Rodway is an assistant professor, School of Medicine, University of Nevada, Reno, Nevada
| | - Xiao Hu
- Xiao Hu is a professor, School of Nursing, Duke University, Durham, North Carolina
| | - Michele M Pelter
- Michele M. Pelter is an associate professor, School of Nursing, University of California, San Francisco, California
| |
Collapse
|
7
|
Madsen JM, Wichmann S, Bestle MH, Itenov TS. Bioimpedance as a measure of fluid status in critically ill patients: A systematic review. Acta Anaesthesiol Scand 2021; 65:1155-1167. [PMID: 34036559 DOI: 10.1111/aas.13924] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Janne M. Madsen
- Department of Anaesthesiology Copenhagen University Hospital—North Zealand Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Sine Wichmann
- Department of Anaesthesiology Copenhagen University Hospital—North Zealand Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesiology Copenhagen University Hospital—North Zealand Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Theis S. Itenov
- Department of Anaesthesiology Copenhagen University Hospital—North Zealand Copenhagen Denmark
| |
Collapse
|
8
|
Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness. Curr Opin Crit Care 2021; 27:344-353. [PMID: 33967207 PMCID: PMC8270506 DOI: 10.1097/mcc.0000000000000840] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
Collapse
|
9
|
Karpavičiūtė J, Skarupskienė I, Balčiuvienė V, Vaičiūnienė R, Žiginskienė E, Bumblytė IA. Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury. ACTA ACUST UNITED AC 2021; 57:medicina57060518. [PMID: 34067299 PMCID: PMC8224573 DOI: 10.3390/medicina57060518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Justina Karpavičiūtė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Correspondence:
| | - Inga Skarupskienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Vilma Balčiuvienė
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Rūta Vaičiūnienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Edita Žiginskienė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| | - Inga Arūnė Bumblytė
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania; (I.S.); (R.V.); (E.Ž.); (I.A.B.)
- Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania;
| |
Collapse
|
10
|
Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput 2020; 34:401-410. [PMID: 31808061 PMCID: PMC7223384 DOI: 10.1007/s10877-019-00439-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ivan Myatchin
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium
- Department Anaesthesiology, Sint-Trudo Regional Hospital, Sint-Truiden, Belgium
| | - Paul Abraham
- Anaesthesiology and Critical Care Medicine Department, Hôpital Edouard-Herriot, Lyon Cedex 03, France
| | - Manu L N G Malbrain
- Department Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium.
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Elsene, Belgium.
| |
Collapse
|