Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients

Abstract

A bstract Background Intravenous fluid optimization is an essential component of managing patients in a critical care setting. A cumulative positive fluid balance is consistent with poor outcomes in patients admitted to the intensive care unit (ICU). The overall utility of net cumulative fluid balance as a surrogate for assessing fluid overload has been interrogated. Materials and methods This study was a prospective single-center observational study, which was done to correlate body weight changes with fluid balance in ICU patients and evaluate its impact on clinical outcomes. Inclusion criteria consisted of adult patients who were admitted to the critical care unit on specialized beds with integrated weighing scales between September 2017 and December 2018. The evaluation of the effect of changes in body weight on ICU survival was the primary objective of the study. Results We enrolled 105 patients in this study. The ICU mortality was 23.80% with non-survivors showing more weight gain than the survivors. Statistically significant weight gain was documented in the non-survivors on days 3 and 4 (1.9 vs 1.05; p = 0.0084 and 2.6 vs 1.6; p = 0.0030) of ICU admission. Non-survivors had greater cumulative positive fluid balance on fourth, fifth, and sixth days post-ICU admission when compared to survivors (3586 vs 1659 mL, p = 0.0322; 5418 vs 1255 mL, p = 0.0017; and 5430 vs 2305 mL p = 0.0264, respectively). In multivariate regression analysis, cumulative fluid balance did not correlate with days on mechanical ventilation or length of stay in ICU. Changes in body weight and cumulative fluid balance showed a good correlation. Conclusion In patients admitted to the ICU, weight gain on third and fourth days of admission is concordant with increased ICU mortality. Body weight changes were seen to correlate well with the cumulative fluid balance. How to cite this article Mishra RK, Pande A, Ramachandran R, Trikha A, Singh PM, Rewari V. Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients. Indian J Crit Care Med 2021;25(9):1042–1048.

Daily weight monitoring for inpatients receiving chemotherapy

“…fluid volume chemotherapy regimens. 8 These patients can easily develop volume overload, even with no preexisting history of cardiac or renal comorbidities. With intake and output often being inaccurate and inconsistent, daily weights are a simple intervention for identifying early volume overload, especially when other signs or symptoms may not be present.…”

“…However, daily weight measurement is an accurate and reliable method of monitoring fluid volume balance in patients receiving high I.V. fluid volume chemotherapy regimens 8…”

“…The review did not support intake and output documentation as the only method for estimating fluid volume status. Davies et al 4 8 which aimed to correlate body weight changes with fluid balance in ICU patients and evaluate its impact on clinical outcomes. Body weight measurements in this study were done with ICU beds, which have integrated in-bed weighing scales.…”

“…The authors concluded that body weight changes correlate well with cumulative fluid balance and may be used as a surrogate marker. 8 Weight measurements must be consistent to collect accurate data.…”

“…All ICU nurses were educated in the correct procedure for weighing patients before the start of the study. The authors concluded that body weight changes correlate well with cumulative fluid balance and may be used as a surrogate marker 8…”