eISSN: 1731-2531
ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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1/2021
vol. 53
 
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abstract:
Original paper

Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study

Robbert Cleymaet
1, 2
,
Thomas Scheinok
1
,
Hanne Maes
1
,
Amber Stas
1
,
Luca Malbrain
3
,
Inneke De laet
4
,
Karen Schoonheydt
4
,
Hilde Dits
4
,
Niels van Regenmortel
4
,
Michaël Mekeirele
1
,
Andrea Minini
1, 5
,
Paolo Severgnini
5, 6
,
Adrian Wong
7
,
Manu L.N.G. Malbrain
4, 8, 9

1.
Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
2.
Faculty of Medicine and Health Sciences, Universiteit Gent (UGent), Gent, Belgium
3.
University School of Medicine, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
4.
Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
5.
School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, Varese, Italy
6.
Department of Anestesia e Rianimazione Cardiologica, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi , Varese, Italy
7.
Department of Intensive Care Medicine and Anaesthesia, King’s College Hospital, Denmark Hill, London, UK
8.
Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
9.
International Fluid Academy, Lovenjoel, Belgium
Anaesthesiol Intensive Ther 2021; 53, 1: 10–17
Online publish date: 2021/02/23
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Introduction
The non-invasive analysis of body fluid composition with bio-electrical impedance analysis (BIA) provides additional information allowing for more persona­lised therapy to improve outcomes. The aim of this study is to assess the prognostic value of fluid overload (FO) in the first week of intensive care unit (ICU) stay.

Material and methods
A retrospective, observational analysis of 101 ICU patients. Whole-body BIA measurements were performed, and FO was defined as a 5% increase in volume excess from baseline body weight.

Results
Baseline demographic data, including severity scores, were similar in both the fluid overload-positive (FO+, n = 49) patients and in patients without fluid overload (FO–, n = 52). Patients with FO+ had significantly higher cumulative fluid balance during their ICU stay compared to those without FO (8.8 ± 7.0 vs. 5.5 ± 5.4 litres; P = 0.009), VE (9.9 ± 6.5 vs. 1.5 ± 1.5 litres; P < 0.001), total body water (63.0 ± 9.5 vs. 52.8 ± 8.1%; P < 0.001), and extracellular water (27.0 ± 7.3 vs. 19.6 ± 3.7 litres; P < 0.001). The presence of 5%, 7.5%, and 10% fluid overload was directly associated with increased ICU mortality rates. The percentage fluid overload (P = 0.039) was an independent predictor for hospital mortality.

Conclusions
A higher mortality rate in ICU-patients with FO was observed. FO is an independent prognostic factor because neither APACHE-II, SOFA, nor SAPS-II significantly differed on admission between survivors and non-survivors. Further research is needed to confirm these data prospectively and to evaluate whether BIA-guided deresuscitation in the subacute phase will improve mortality rates.

keywords:

fluids, overload, bio-electrical impedance analysis, BIA, volume excess, outcome, crtitically ill, total body water, extracellular water, lung water

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