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Gutiérrez-Carretero E, Campos AM, Giménez-Miranda L, Rezaei K, Peña A, Rossel J, Praena JM, Smani T, Ordoñez A, Medrano FJ. [Prognostic value of electrical bioimpedance measured with a portable and wireless device in acute heart failure]. Med Clin (Barc) 2024; 163:175-182. [PMID: 38821829 DOI: 10.1016/j.medcli.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION AND OBJECTIVES The current evaluation of acute heart failure (HF) does not allow an adequate prediction of its evolution. The electrical bioimpedance (BI) allows knowing the state of blood volume, until now only with fixed equipment. We have developed and validated a portable and wireless device to measure BI at the ankle (IVOL). The objective of the study is to know the long-term prognostic value of the point measurement of BI with IVOL in patients with acute HF. METHODS A prospective cohort study of unselected patients admitted for acute HF in a tertiary hospital. The association between BI and different clinical, analytical and echocardiographic variables on admission and clinical evolution were analyzed. RESULTS 76 patients were included (mean age 66.1 years, 71.1% men, 68.4% hypertensive, 34.2% diabetic, mean NT-ProBNP: 7,103 pg / ml). Of these, 52.6% with non-preserved left ventricular ejection fraction (LVEF) (<50%) and 56.6% with right ventricular (RV) dysfunction. 26.3% died during a mean follow-up of 35.8 months. Survival in patients with BI≤21,8Ω was lower, globally and in the subgroups of patients without preserved LVEF and with RV dysfunction, P<.008). In the multivariate analysis, a BI≥21.8Ω was an independent survival factor (HR: 0.242; 95% CI: 0.86-0.681; P=.007). CONCLUSIONS BI values measured with IVOL may be an independent predictor of long-term mortality in patients hospitalized for acute HF. This prognostic value is maintained in patients without preserved LVEF function and with RV dysfunction.
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Affiliation(s)
- Encarnación Gutiérrez-Carretero
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Ana María Campos
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Luis Giménez-Miranda
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Kambitz Rezaei
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Amelia Peña
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Javier Rossel
- Departamento de Ingeniería Electrónica, Universidad Politécnica de Cataluña, Barcelona, España
| | - Juan Manuel Praena
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Enfermería, Universidad de Sevilla, Sevilla, España
| | - Tarik Smani
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España
| | - Antonio Ordoñez
- Unidad Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España; Departamento de Cirugía, Universidad de Sevilla, Sevilla, España.
| | - Francisco Javier Medrano
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Virgen del Rocio, CSIC, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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2
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Rodríguez-López C, Balaguer Germán J, Venegas Rodríguez A, Carda Barrio R, Gaebelt Slocker HP, Pello Lázaro AM, López Castillo M, Soler Bonafont B, Recio Vázquez M, Taibo Urquía M, González Piña M, González Parra E, Tuñón J, Aceña Á. Bioimpedance analysis predicts worsening events in outpatients with heart failure and reduced ejection fraction. ESC Heart Fail 2024. [PMID: 39044354 DOI: 10.1002/ehf2.14908] [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: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 07/25/2024] Open
Abstract
AIMS Heart failure (HF) with reduced left ventricle ejection fraction (LVEF) is an entity with poor prognosis characterized by decompensations. Bioelectrical impedance analysis (BIA) is used to assess volume overload (VO) and may be useful to identify apparently stable HF outpatients at risk of decompensation. The aim of this study is to analyse whether VO assessed by BIA is associated with worsening heart failure (WHF) in stable outpatients with HF and reduced LVEF (HFrEF). METHODS AND RESULTS This is a prospective single-centre observational study. Consecutive stable HF outpatients with LVEF below 40% underwent BIA, transthoracic echocardiography, blood sampling, and physical examination and were followed up for 3 months. VO was defined as the difference between the measured weight and the dry weight assessed by BIA. Demographic, clinical, anthropometric, echocardiographic, and analytical parameters were recorded. The primary endpoint was WHF, defined by visits to the emergency department for HF or hospitalization for HF. A total of 100 patients were included. The median VO was 0.5 L (interquartile range 0-1.6 L). Eleven patients met the primary endpoint. Univariate binary logistic regression analysis showed that left ventricle filling pressures assessed by E/e', N-terminal pro B-type natriuretic peptide, inferior vena cava dilatation (≥21 mm), signs of congestion, and VO were associated with the primary endpoint. Binary logistic regression multivariate analysis showed that VO was the only independent predictor for the primary endpoint (adjusted OR 2.7; 95% CI 1.30-5.63, P = 0.008). Multivariate Cox regression analysis also showed an adjusted hazard ratio (HR) for VO of 2.03; 95% CI 1.37-3.02, P < 0.001. Receiver-operating characteristic curve analysis showed an area under the curve for VO of 0.88 (95% CI 0.79-0.97, P < 0.001) with an optimal cut-off of 1.2 L. CONCLUSIONS VO assessed by BIA is independently associated with WHF in stable outpatients with HFrEF at 3 months.
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Affiliation(s)
| | | | | | - Rocío Carda Barrio
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Marta López Castillo
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Bárbara Soler Bonafont
- Department of Internal Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Mónica Recio Vázquez
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Mikel Taibo Urquía
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María González Piña
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Emilio González Parra
- Department of Nephrology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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3
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Lopes MMGD, Sousa IM, Queiroz SA, Bezerra MRO, Gonzalez MC, Fayh APT. Bioelectrical impedance vector analysis is different according to the comorbidity burden in post-acute myocardial infarction. Nutr Clin Pract 2024; 39:450-458. [PMID: 37740504 DOI: 10.1002/ncp.11074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/01/2023] [Accepted: 08/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post-AMI. METHODS This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre-existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed-up until hospital discharge, and their length of stay was observed. RESULTS A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3. CONCLUSION Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post-AMI to improve their clinical status.
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Affiliation(s)
- Marcia M G D Lopes
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Applied Sciences to Women's Health, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Iasmin M Sousa
- Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sandra Azevedo Queiroz
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mara R O Bezerra
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maria Cristina Gonzalez
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ana Paula Trussardi Fayh
- Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Wittczak A, Ślot M, Bielecka-Dabrowa A. The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid. Biomedicines 2023; 11:2684. [PMID: 37893057 PMCID: PMC10604032 DOI: 10.3390/biomedicines11102684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.
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Affiliation(s)
- Andrzej Wittczak
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Maciej Ślot
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Faculty of Physics and Applied Informatics, University of Lodz, 90-236 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
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5
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Venegas‐Rodríguez A, Pello AM, López‐Castillo M, Taibo Urquía M, Balaguer‐Germán J, Munté A, González‐Martín G, Carriazo‐Julio SM, Martínez‐Milla J, Kallmeyer A, González Lorenzo Ó, Gaebelt Slocker HP, Tuñón J, González‐Parra E, Aceña Á. The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study. ESC Heart Fail 2023; 10:2418-2426. [PMID: 37226407 PMCID: PMC10375164 DOI: 10.1002/ehf2.14398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/09/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
AIMS Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients.
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Affiliation(s)
- Ana Venegas‐Rodríguez
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Ana María Pello
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Marta López‐Castillo
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Mikel Taibo Urquía
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Jorge Balaguer‐Germán
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Alicia Munté
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
| | | | | | - Juan Martínez‐Milla
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)C. de Melchor Fernández Almagro, 3Madrid28029Spain
| | - Andrea Kallmeyer
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Óscar González Lorenzo
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | | | - José Tuñón
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
| | - Emilio González‐Parra
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
- Department of NephrologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Álvaro Aceña
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
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Thanapholsart J, Khan E, Lee GA. A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource? Biol Res Nurs 2023; 25:240-249. [PMID: 36342073 PMCID: PMC10021121 DOI: 10.1177/10998004221132838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients. METHOD A systematic search was conducted. RESULT Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated. CONCLUSION The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.
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Affiliation(s)
- Jenjiratchaya Thanapholsart
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Ehsan Khan
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Geraldine A Lee
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
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Lima J, Eckert I, Gonzalez MC, Silva FM. Prognostic value of phase angle and bioelectrical impedance vector in critically ill patients: A systematic review and meta-analysis of observational studies. Clin Nutr 2022; 41:2801-2816. [PMID: 36395589 DOI: 10.1016/j.clnu.2022.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Assessment of the raw parameters derived from bioelectrical impedance analysis (BIA) has gained emphasis in critically ill patients. The phase angle (PhA) reflects the integrity of the cell membrane, and bioelectrical impedance vector analysis (BIVA) is indicative of patients' hydration status. The aim of this study was to investigate whether these parameters are associated with clinical outcomes in the intensive care unit (ICU) setting. METHODS We conducted a systematic review with meta-analysis. We searched PubMed, Embase, Scopus and Web of Science for all published observational studies without language restrictions up to April 2022. Two reviewers independently performed study selection and data extraction. We judged the risk of bias by the Newcastle-Ottawa Scale and the certainty of evidence by the GRADE approach. Mortality was the primary outcome. Secondary outcomes included ICU length of stay, hospital length of stay, duration of mechanical ventilation, nutritional risk, and malnutrition. A meta-analysis with a random-effect model was performed to combine data on R version 3.6.2. RESULTS Twenty-seven studies were included in the systematic review (4872 participants). Pooled analysis revealed that patients with low PhA had a higher risk of death (14 studies; RR = 1.82, 95% CI 1.46 to 2.26; I2 = 42%) and spent more days in ICU (6 studies; MD = 1.79, 95% CI 0.33 to 3.24, I2 = 69%) in comparison to patients with normal PhA. The pooled analysis also showed higher PhA values in survivors compared to non-survivor patients (12 studies; MD = 0.75°, 95% CI 0.60° to 0.91°, I2 = 31%). Overhydration defined by BIVA was not a predictor of mortality (4 studies; RR = 1.01, 95% CI 0.70 to 1.46; I2 = 0%). More than 40% of primary studies were classified with a high risk of bias, and the quality of evidence ranged from low to very low. CONCLUSIONS This meta-analysis revealed, with limited evidence, that low PhA was associated with higher mortality and ICU length of stay, while overhydration identified by BIVA was not a predictor of death in critically ill patients.
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Affiliation(s)
- Júlia Lima
- Master Student at Nutrition Science Graduate Program Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Maria Cristina Gonzalez
- Professor at Graduate Program in Health and Behavior, Catholic University of Pelotas, Rio Grande do Sul, Brazil
| | - Flávia Moraes Silva
- Professor at Nutrition Department and Nutrition Science Graduate Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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8
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Mayne KJ, Shemilt R, Keane DF, Lees JS, Mark PB, Herrington WG. Bioimpedance Indices of Fluid Overload and Cardiorenal Outcomes in Heart Failure and Chronic Kidney Disease: a Systematic Review. J Card Fail 2022; 28:1628-1641. [PMID: 36038013 PMCID: PMC7613800 DOI: 10.1016/j.cardfail.2022.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bioimpedance-based estimates of fluid overload have been widely studied and systematically reviewed in populations of those undergoing dialysis, but data from populations with heart failure or nondialysis chronic kidney disease (CKD) have not. METHODS AND RESULTS We conducted a systematic review of studies using whole-body bioimpedance from populations with heart failure and nondialysis CKD that reported associations with mortality, cardiovascular outcomes and/or CKD progression. We searched MEDLINE, Embase databases and the Cochrane CENTRAL registry from inception to March 14, 2022. We identified 31 eligible studies: 20 heart failure and 11 CKD cohorts, with 2 studies including over 1000 participants. A wide range of various bioimpedance methods were used across the studies (heart failure: 8 parameters; CKD: 6). Studies generally reported positive associations, but between-study differences in bioimpedance methods, fluid overload exposure definitions and modeling approaches precluded meta-analysis. The largest identified study was in nondialysis CKD (Chronic Renal Insufficiency Cohort, 3751 participants), which reported adjusted hazard ratios (95% confidence intervals) for phase angle < 5.59 vs ≥ 6.4 of 2.02 (1.67-2.43) for all-cause mortality; 1.80 (1.46-2.23) for heart failure events; and 1.78 (1.56-2.04) for CKD progression. CONCLUSIONS Bioimpedance indices of fluid overload are associated with risk of important cardiorenal outcomes in heart failure and CKD. Facilitation of more widespread use of bioimpedance requires consensus on the optimum device, standardized analytical methods and larger studies, including more detailed characterization of cardiac and renal phenotypes.
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Affiliation(s)
- Kaitlin J Mayne
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
| | - Richard Shemilt
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - David F Keane
- CÚRAM SFI Research Centre for Medical Devices, HRB-Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland
| | - Jennifer S Lees
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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De Ieso F, Mutke MR, Brasier NK, Raichle CJ, Keller B, Sucker C, Abdelhamid K, Bloch T, Reissenberger P, Schönenberg L, Fischer SK, Saboz J, Weber N, Schädelin S, Bruni N, Wright PR, Eckstein J. Body composition analysis in patients with acute heart failure: the Scale Heart Failure trial. ESC Heart Fail 2021; 8:4593-4606. [PMID: 34647695 PMCID: PMC8712800 DOI: 10.1002/ehf2.13641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/29/2021] [Accepted: 09/19/2021] [Indexed: 01/10/2023] Open
Abstract
Aims In this study, we aimed to investigate whether body composition analysis (BCA) derived from bioelectrical impedance vector analysis (BIVA) could be used to monitor the hydration status of patients with acute heart failure (AHF) during intensified diuretic therapy. Methods and results This observational, single‐centre study involved a novel, validated eight‐electrode segmental body composition analyser to perform BCA derived from BIVA with an alternating current of 100 μA at frequencies of 5, 7.5, 50, and 75 kHz. The BCA‐derived and BIVA‐derived parameters were estimated and compared with daily body weight measurements in hospitalized patients with AHF. A total of 867 BCA and BIVA assessments were conducted in 142 patients (56.3% men; age 76.8 ± 10.7 years). Daily changes in total body water (TBW) and extracellular water (ECW) were significantly associated with changes in body weight in 62.2% and 89.1% of all measurements, respectively (range, ±1 kg). Repeated measures correlation coefficients between weight loss and TBW loss resulted with rho 0.43, P < 0.01, confidence interval (CI) [0.36, 0.50] and rho 0.71, P > 0.01, CI [0.67, 0.75] for ECW loss. Between the first and last assessments, the mean weight loss was −2.5 kg, compared with the −2.6 L mean TBW loss and −1.7 L mean ECW loss. BIVA revealed an increase in mean Resistance R and mean Reactance Xc across all frequencies, with the subsequent reduction in body fluid (including corresponding body weight) between the first and last assessments. Conclusions Body composition analysis derived from BIVA with a focus on ECW is a promising approach to detect changes in hydration status in patients undergoing intensified diuretic therapy. Defining personalized BIVA reference values using bioelectrical impedance devices is a promising approach to monitor hydration status.
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Affiliation(s)
- Fiorangelo De Ieso
- CMIO Office, University Hospital Basel, Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Markus Reinhold Mutke
- CMIO Office, University Hospital Basel, Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | | | - Christina Janitha Raichle
- CMIO Office, University Hospital Basel, Basel, Switzerland.,Department of Gastroenterology, University Hospital Basel, Basel, Switzerland
| | - Bettina Keller
- CMIO Office, University Hospital Basel, Basel, Switzerland
| | - Celine Sucker
- CMIO Office, University Hospital Basel, Basel, Switzerland
| | | | - Tiziano Bloch
- CMIO Office, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Jonas Saboz
- CMIO Office, University Hospital Basel, Basel, Switzerland
| | - Nora Weber
- CMIO Office, University Hospital Basel, Basel, Switzerland
| | - Sabine Schädelin
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Nicole Bruni
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Jens Eckstein
- CMIO Office, University Hospital Basel, Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
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10
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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.
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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;
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11
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Hankinson SJ, Williams CH, Ton VK, Gottlieb SS, Hong CC. Should we overcome the resistance to bioelectrical impedance in heart failure? Expert Rev Med Devices 2020; 17:785-794. [PMID: 32658589 PMCID: PMC8356137 DOI: 10.1080/17434440.2020.1791701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Heart failure is associated with increased neurohormonal activation that results in changes in body composition including volume overload and the loss of skeletal muscle, body fat, and bone density. Bioelectrical impedance measures body composition based on the conduction of electrical current through body fluids. AREAS COVERED The PubMed and Scopus databases were reviewed up to the third week of June 2020. Cross-sectional studies, retrospective observational studies, prospective observational studies, and randomized controlled trials have examined numerous bioelectrical impedance monitoring strategies to guide the diagnosis, prognosis, and treatment of heart failure. These monitoring strategies include intrathoracic impedance, lung impedance, bioelectrical impedance vector analysis, leg bioelectrical impedance, and thoracic bioreactance. EXPERT COMMENTARY Based on the current evidence, more studies are needed to validate bioelectrical impedance in heart failure. Lung impedance appears to be useful for guiding heart failure treatment in patients with ST-elevation myocardial infarction and improving outcomes in outpatients with heart failure. Furthermore, bioelectrical impedance has potential as a noninvasive, quantitative heart failure variable for population-based research.
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Affiliation(s)
- Stephen J. Hankinson
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles H. Williams
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van-Khue Ton
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Harvard Medical School, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen S. Gottlieb
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles C. Hong
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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12
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Chang HC, Huang CJ, Cheng HM, Yu WC, Chiang CE, Sung SH, Chen CH. Nocturnal thoracic volume overload and post-discharge outcomes in patients hospitalized for acute heart failure. ESC Heart Fail 2020; 7:2807-2817. [PMID: 32681759 PMCID: PMC7524107 DOI: 10.1002/ehf2.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023] Open
Abstract
Aims Volume overload and perturbations of pulsatile haemodynamics may precipitate acute heart failure (AHF). Nocturnal thoracic volume overload due to rostral fluid shift during recumbency undetected by daytime measures may impact nighttime haemodynamics and post‐discharge outcomes. Methods and results A total of 63 patients (median 60 years, 79.4% men, and left ventricular ejection fraction 29.4%) hospitalized for AHF were enrolled. Once clinical euvolaemia was achieved, noninvasive pulsatile haemodynamics were assessed during daytime followed by circadian monitoring (6 p.m. to 5 a.m.) of thoracic fluid content and thoracic fluid content index (TFCi) using impedance cardiography, normalized electromechanical activation time ratio (EMAT%) using acoustic cardiography, and mean blood pressure using ambulatory blood pressure monitoring before discharge. The primary endpoints were composited of the first hospitalization for heart failure and death from any cause. Patients were also followed for the repeated heart failure hospitalizations. During a median follow‐up duration of 16 months, 33 patients encountered primary composite endpoints (52.4%), and there were 42 hospitalizations developed among 25 patients. An overnight increase in TFCi along with persistently prolonged EMAT% and low mean blood pressure was observed in the eventful group. Overnight increase in TFCi (ΔTFCi, the difference between the measures at 4 a.m. and 6 p.m.) was an independent predictor of primary composite events (hazard ratio and 95% confidence interval: 1.58, 1.07–2.33; P = 0.022) and recurrent composite events (2.22, 1.51–3.26; P < 0.001), after adjusting for potential confounding factors. A high ΔTFCi (≥0.5/kΩ/m2) significantly correlated with higher post‐discharge events (hazard ratio 6.25; 95% confidence interval 2.30–16.96; P < 0.001) in comparison with a low ΔTFCi (<0.5/kΩ/m2). ΔTFCi was significantly associated with EMAT%, estimated glomerular filtration rate, and left ventricular ejection fraction, but not with parameters of pulsatile haemodynamics. Conclusions Nocturnal thoracic volume overload in AHF before discharge, indicating the presence of residual volume overload unidentified by daytime measures, may predict post‐discharge outcomes.
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Affiliation(s)
- Hao-Chih Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Huang
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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13
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Kammar-García A, Castillo-Martínez L, Villanueva-Juárez JL, Pérez-Pérez A, Rocha-González HI, Arrieta-Valencia J, Remolina-Schlig M, Hernández-Gilsoul T. Comparison of Bioelectrical Impedance Analysis Parameters for the Detection of Fluid Overload in the Prediction of Mortality in Patients Admitted at the Emergency Department. JPEN J Parenter Enteral Nutr 2020; 45:414-422. [PMID: 32441793 DOI: 10.1002/jpen.1848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Fluid overload (FO) in critically ill patients is associated with increased adverse events. This study aims to compare different bioelectrical impedance analysis (BIA) parameters that demonstrate FO and their association with 30-day mortality in critical patients admitted to the emergency department (ED). METHODS Five components of the BIA were obtained by multifrequency device-total body water (TBW), extracellular water (ECW), intracellular water (ICW), resistance (R), and reactance (Xc)-to calculate parameters (impedance vectors, impedance ratio, and the ratios of ECW to TBW, ECW to ICW, ECW to body surface area, TBW to height2 , ICW to height2 , Xc to height, and R to height) that have been used for the detection of FO. A concordance analysis (κ) was performed comparing every parameter with each other. Furthermore, different regression models (Cox regression) were created associating the FO for each parameter with 30-day mortality, adjusted for age, body mass index, sex, Sequential Organ Failure Assessment score, and serum albumin level. RESULTS A total of 142 patients were included in the study. Only FO by impedance vector analysis (relative risk [RR] = 6.4; 95% CI, 1.5-27.9; P = .01), impedance ratio (RR = 2.7; 95% CI, 1.1-7.1; P = .04), and R (RR = 2.6; 95% CI, 1.2-5.5; P = .02) increased the probability of 30-day mortality. CONCLUSIONS Different parameters that determine FO by BIA were associated with the mortality of patients admitted to the ED, but the impedance vector analysis was superior to any other parameter of the BIA.
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Affiliation(s)
- Ashuin Kammar-García
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México City, México
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - José Luis Villanueva-Juárez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Anayeli Pérez-Pérez
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Héctor Isaac Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México City, México
| | - Jesús Arrieta-Valencia
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México City, México
| | - Miguel Remolina-Schlig
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Thierry Hernández-Gilsoul
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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14
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Scicchitano P, Massari F. Bioimpedance vector analysis in the evaluation of congestion in heart failure. Biomark Med 2020; 14:81-85. [PMID: 32053026 DOI: 10.2217/bmm-2019-0429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Pietro Scicchitano
- Department of Cardiology, Hospital 'F. Perinei' Altamura, Altamura, Apulia, Italy.,Department of Cardiology, University 'A. Moro' Bari, Bari, Apulia, Italy
| | - Francesco Massari
- Department of Cardiology, Hospital 'F. Perinei' Altamura, Altamura, Apulia, Italy
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15
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Göz M, Sert C, Hazar A, Aydın MS, Kankılıç N. Bioelectrical Impedance Analysis for Monitoring Fluid and Body Cell Mass Changes in Patients Undergoing Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2020; 35:16-21. [PMID: 32270955 PMCID: PMC7089741 DOI: 10.21470/1678-9741-2019-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. METHODS Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients' values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. RESULTS Total body fluid changed significantly after cardiopulmonary bypass (P<0.01). Metabolic velocity significantly changed compared to preoperative measurements (P<0.05). Fat mass and lean body mass also changed significantly. Body mass index and phase angle did not change significantly (P>0.05). CONCLUSION Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.
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Affiliation(s)
- Mustafa Göz
- Harran University Medical School Department of Cardiovascular Surgery Şanliurfa Turkey Department of Cardiovascular Surgery, Medical School of Harran University, Şanliurfa, Turkey
| | - Cemil Sert
- Harran University Medical School Department of Biophysics Şanliurfa Turkey Department of Biophysics, Medical School of Harran University, Şanliurfa, Turkey
| | - Abdussamet Hazar
- Malatya Education and Research Hospital Department of Cardiovascular Surgery Malatya Turkey Department of Cardiovascular Surgery, Malatya Education and Research Hospital, Malatya, Turkey
| | - Mehmet Salih Aydın
- Harran University Medical School Department of Cardiovascular Surgery Şanliurfa Turkey Department of Cardiovascular Surgery, Medical School of Harran University, Şanliurfa, Turkey
| | - Nazim Kankılıç
- Harran University Medical School Department of Cardiovascular Surgery Şanliurfa Turkey Department of Cardiovascular Surgery, Medical School of Harran University, Şanliurfa, Turkey
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16
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Multiparametric approach to congestion for predicting long-term survival in heart failure. J Cardiol 2020; 75:47-52. [PMID: 31326239 DOI: 10.1016/j.jjcc.2019.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 01/30/2023]
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17
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Massari F, Scicchitano P, Iacoviello M, Valle R, Sanasi M, Piscopo A, Guida P, Mastropasqua F, Caldarola P, Ciccone MM. Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure. Heart Lung 2019; 48:395-399. [PMID: 31113676 DOI: 10.1016/j.hrtlng.2019.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023]
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18
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González-Islas D, Arámbula-Garza E, Orea-Tejeda A, Castillo-Martínez L, Keirns-Davies C, Salgado-Fernández F, Hernández-Urquieta L, Hernández-López S, Pilotzi-Montiel Y. Body composition changes assessment by bioelectrical impedance vectorial analysis in right heart failure and left heart failure. Heart Lung 2019; 49:42-47. [PMID: 31421949 DOI: 10.1016/j.hrtlng.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/28/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart Failure (HF) patients developed changes in body composition as overhydration, muscle-skeletal wear and cardiac cachexia (CC). The possible factors involved in the development of CC in Right Heart Failure (RHF) patients are venous congestion, nutrient malabsorption. However, in HF, the overhydration obscure the loss of fat-free mass and difficult the body composition assessment. Bioelectrical impedance vectorial analysis (BIVA) is a method validated and used for hydration status and body composition assessment in HF. The aim of this study was to investigate the body compositions changes assessment by BIVA in the subjects with and without RHF and evaluate the risk factors for devolvement CC in HF subjects. MATERIAL AND METHODS Prospective cohort study. Subjects with confirmed diagnoses of HF, >18 years old without CC according to BIVA criteria were included. Subjects with congenital heart disease, cancer, HIV, and end-stage renal disease were excluded. Body composition was an assessment by BIVA. 288 HF patients were evaluated. RHF subjects had an impedance vector reduction (9.26 dR/H and -1.92 dXc/H, T2=14.9, D = 0.45, p<0.001), while subjects without RHF no-showed statistically significant changes (7.57 dR/H and 0.72 dXc/H, T2=3, D = 0.17, p = 0.200). The risks factors to development CC were age, RHF, phase angle < 5°, total body water were risks factors while handgrip strength was a protector factor. CONCLUSIONS RHF has greater disturbances in body composition and is a risk factor to development CC.
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Affiliation(s)
- Dulce González-Islas
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Estefanía Arámbula-Garza
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.
| | - Lilia Castillo-Martínez
- Mexico and Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Candace Keirns-Davies
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico.
| | - Fernanda Salgado-Fernández
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Luis Hernández-Urquieta
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Samantha Hernández-López
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Yuridia Pilotzi-Montiel
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
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19
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Lukaski HC, Vega Diaz N, Talluri A, Nescolarde L. Classification of Hydration in Clinical Conditions: Indirect and Direct Approaches Using Bioimpedance. Nutrients 2019; 11:nu11040809. [PMID: 30974817 PMCID: PMC6521329 DOI: 10.3390/nu11040809] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022] Open
Abstract
Although the need to assess hydration is well recognized, laboratory tests and clinical impressions are impractical and lack sensitivity, respectively, to be clinically meaningful. Different approaches use bioelectrical impedance measurements to overcome some of these limitations and aid in the classification of hydration status. One indirect approach utilizes single or multiple frequency bioimpedance in regression equations and theoretical models, respectively, with anthropometric measurements to predict fluid volumes (bioelectrical impedance spectroscopy-BIS) and estimate fluid overload based on the deviation of calculated to reference extracellular fluid volume. Alternatively, bioimpedance vector analysis (BIVA) uses direct phase-sensitive measurements of resistance and reactance, measured at 50 kHz, normalized for standing height, then plotted on a bivariate graph, resulting in a vector with length related to fluid content, and direction with phase angle that indexes hydration status. Comparison with healthy population norms enables BIVA to classify (normal, under-, and over-) and rank (change relative to pre-treatment) hydration independent of body weight. Each approach has wide-ranging uses in evaluation and management of clinical groups with over-hydration with an evolving emphasis on prognosis. This review discusses the advantages and limitations of BIS and BIVA for hydration assessment with comments on future applications.
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Affiliation(s)
- Henry C Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND 58202-7166, USA.
| | - Nicanor Vega Diaz
- Nephrology Service, University Hospital of Grand Canary and Faculty of Science, University Los Palmas, 35019 Los Palmas, Grand Canary, Spain.
| | - Antonio Talluri
- Antonio Talluri, Fatbyte, Inc., 50012 Bagno a Ripoli, Florence, Italy.
| | - Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain.
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Curbelo J, Rodriguez-Cortes P, Aguilera M, Gil-Martinez P, Martín D, Suarez Fernandez C. Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure. Curr Med Res Opin 2019; 35:705-713. [PMID: 30185067 DOI: 10.1080/03007995.2018.1519502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF. METHODS This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF. RESULTS Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000 pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve. CONCLUSION Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.
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Affiliation(s)
- Jose Curbelo
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Pablo Rodriguez-Cortes
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Maria Aguilera
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Paloma Gil-Martinez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Daniel Martín
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Carmen Suarez Fernandez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
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21
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da Silva AT, Hauschild DB, de Almeida Oliveira LD, de Fragas Hinnig P, Franco Moreno YM, Wazlawik E. Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses. Clin Nutr ESPEN 2018; 28:12-20. [DOI: 10.1016/j.clnesp.2018.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/09/2023]
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Price KL, Earthman CP. Update on body composition tools in clinical settings: computed tomography, ultrasound, and bioimpedance applications for assessment and monitoring. Eur J Clin Nutr 2018; 73:187-193. [DOI: 10.1038/s41430-018-0360-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 12/31/2022]
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Noninvasive Bioelectrical Impedance for Predicting Clinical Outcomes in Outpatients With Heart Failure. Crit Pathw Cardiol 2017; 16:32-36. [PMID: 28195941 DOI: 10.1097/hpc.0000000000000105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Noninvasive bioelectrical impedance analysis (BIA) has shown promise in acute heart failure (HF) management. To our knowledge, its use in predicting outcomes in outpatients with chronic HF patients has not been well described. METHODS AND RESULTS BIA assessment of edema index was performed in 359 outpatients with HF using the InBody 520 scale. Edema index was calculated by dividing extracellular by total body water. Patients were stratified into those with low (≤0.39) and high (>0.39) edema indices. The outcome of interest was death, urgent transplant, or ventricular assist device over 2-year follow up. Patients with a high edema index were older, had higher B-type natriuretic peptide values and New York Heart Association Class. Patients with a high edema index had poorer outcomes (unadjusted hazard ratio 1.90, 95% confidence intervals 1.05-3.56). However, in multivariate analyses, a high edema index was not an independent predictor of outcomes (adjusted hazard ratio 1.21, 95% confidence interval 0.51-2.90). CONCLUSIONS A high edema index using a bioimpedance scale in a HF clinic correlated with patient outcomes in unadjusted analyses, but was not a predictor of outcomes once other measures of HF severity are accounted for. As a noninvasive measure of volume status, use of BIA in a HF clinic may be beneficial in determining patient prognosis and treatment when other outcome predictors are not immediately available.
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Hise ACDR, Gonzalez MC. Assessment of hydration status using bioelectrical impedance vector analysis in critical patients with acute kidney injury. Clin Nutr 2017; 37:695-700. [PMID: 28292533 DOI: 10.1016/j.clnu.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS The state of hyperhydration in critically ill patients with acute kidney injury (AKI) is associated with increased mortality. Bioelectrical impedance vector analysis (BIVA) appears to be a viable method to access the fluid status of critical patients but has never been evaluated in critical patients with AKI. The objective of this study is to evaluate the hydration status measured using BIVA in critical patients under intensive care at the time of AKI diagnosis and to correlate this measurement with mortality. METHODS We assessed the fluid status measured using BIVA in 224 critical patients at the time of AKI diagnosis and correlated it with mortality. To interpret the results, BIVA Software 2002 was used to plot the data from the patients studied on the 95% confidence ellipses of the RXc plane for comparisons between groups (non-survivors, survivors). Variables such as mechanical ventilation, vasoactive drug, and sepsis, among others, were collected. RESULTS The impedance vector analysis conducted using BIVA Software 2002 indicated changes in the body compositions of patients according to the 95% confidence ellipse between the vectors R/H and Xc/H of the group of survivors and the group of deceased patients. Hotelling's test (T2 = 21.2) and the F test (F = 10.6) revealed significant differences (p < 0.001) between the two groups. These results demonstrate that patients who died presented with a greater hydration volume at the time of AKI diagnosis compared with those who survived. In addition to the hydration status measured using BIVA, the following were also correlated with death: diagnosis at hospitalization, APACHE II score, length of hospital stay, RIFLE score, maximum organ failure, sepsis type, hemoglobin, and AF. CONCLUSIONS The fluid status assessment measured using BIVA significantly demonstrated the difference in hydration between survivors and non-survivors among critically ill patients with AKI.
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Affiliation(s)
- Ana Cláudia da Rosa Hise
- Post-graduation Program in Health and Behavior, Catholic University of Pelotas, R. Gonçalves Chaves 377, sala 411, CEP 960515-560 Pelotas, RS, Brazil.
| | - Maria Cristina Gonzalez
- Post-graduation Program in Health and Behavior, Catholic University of Pelotas, R. Gonçalves Chaves 377, sala 411, CEP 960515-560 Pelotas, RS, Brazil.
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Forni LG, Hasslacher J, Joannidis M. Bioelectrical impedance vector analysis in the critically ill: cool tool or just another 'toy'? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:387. [PMID: 26556282 PMCID: PMC4641377 DOI: 10.1186/s13054-015-1110-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Assessment of volume and hydration status is far from easy and therefore technology such as bioelectrical impedance vector analysis (BIVA) may complement our examination techniques. This study highlights the fact that clinical assessment of volume balance and BIVA may correlate, but whether the routine use of BIVA will avoid significant volume overload in the critically ill remains unknown. Further studies are needed but at the moment appear a little way off.
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Affiliation(s)
- Lui G Forni
- Department of Intensive Care Medicine, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK. .,Surrey Perioperative Anaesthesia Critical care collaborative Research group (SPACeR) and Faculty of Health Care Sciences, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7TE, UK.
| | - Julia Hasslacher
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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