Measurement of Thoracic Fluid Content in Heart Failure

Folan, Lynn; Funk, Marjorie

doi:10.1097/01.aacn.0000310751.93287.42

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…This finding of ours is supported by previous reports. 11 The improved breathing efforts, less duration of mechanical ventilation, and less inotropic score in Gr D are also supported by previous reports in which TFC was able to follow up the hemodynamic effects of diuretic in hypertensive patients. 5 The utility of intraoperative diuretics and monitoring its effect by TFC can be used as a low-cost therapeutic and diagnostic method for detection and treatment of impending weaning failure in high risk mitral valve disease cases.…”

Section: Discussionsupporting

confidence: 78%

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

Choudhury

Narula

Saini

et al. 2020

Journal of Cardiac Critical Care TSS

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Pulmonary congestion is inevitable in valvular heart disease. The condition worsens when a patient undergoes cardiopulmonary bypass (CPB). Thoracic fluid content (TFC) is an indicator of total volume status of lung in health and disease. We hypothesize that intraoperative diuretic therapy can improve the hemodynamic and clinical outcome in patients undergoing mitral valve surgery by decreasing TFC as measured by impedance cardiography (ICG).Sixty adult patients with critical mitral stenosis scheduled for mitral valve surgery divided into diuretic (Gr D, n = 30) and control (Gr C, n = 30) group. One mg/kg of furosemide was administered before CPB to Gr D and similar volume of normal saline to Gr C. Hemodynamic and TFC measurements were done by index of contractility (ICON), NICOM monitor at baseline, before anesthesia induction (T1), post skin closure (T2), postoperatively at 6th hour (T3), 24th hour (T4), and 48th hour (T5). The duration of mechanical ventilation (hour), intensive care unit stay (day) and inotropic score was significantly higher in Gr C (5.29 ± 1.4 vs. 2.15 ± 1.1; p = 0.001; 2.11 ± 0.64 vs. 1.67 ± 0.57, p = 0.002; 9 ± 5.4 vs. 5.8 ± 3.2, p = 0.05), respectively. Three patients in Gr C developed respiratory complication during their course of hospital stay. The baseline TFC value was comparable (p = 0.08). In Gr C. it gradually increased over time and never reached the baseline value, whereas in Gr D, there was slight increase in TFC till 6th postoperative hour and it came below the baseline value at 48th hour. A significantly higher TFC value in Gr C in comparison with Gr D from 6th to 48th postoperative hour (p = 0.005, 0.000, and 0.005, respectively) was observed.The ICON had a gradual improvement from 12th over 48th postoperative hour in Gr D in comparison to Gr C. The systemic vascular resistance index was decreased over time in Gr C, whereas in Gr D there was a mild fall at the end of surgery and it came back to near the baseline value at 48th postoperative hour. A continuous decrease in DO2 I except at 6th postoperative hour was seen in Gr C, whereas it remained near the baseline value in Gr D.Linear regression analysis showed significant direct correlation of TFC with intraoperative fluid balance (r = 0.524, p = 0.001), cumulative fluid balance (r = 0.680, p = 0.000) and both peak and mean airway pressure (r = 0.436, p = 0.001 and r = 0.548, p = 0.001, respectively).We concluded that TFC is clearly influenced by intraoperative diuretic therapy. A decrease in TFC has an association with better hemodynamic parameters that could find interesting clinical applications in the decision, whether or not to include a diuretic as a routine therapy during intraoperative management in valve surgery patients.

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Section: Discussionsupporting

confidence: 78%

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

Choudhury

Narula

Saini

et al. 2020

Journal of Cardiac Critical Care TSS

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“…Therefore, high TFC value could be an indirect measure of lung congestion and/or hypervolemia which is a known risk factor for failed weaning. This assumption is supported by previous reports in which the TFC was able to follow up the hemodynamic effect of diuretics [15] and to evaluate the thoracic fluid in patients with heart failure [16]. The TFC was also able to follow up the change in the patient body weight and the volume of the ultrafiltrate removed during hemodialysis [17].…”

Section: Discussionsupporting

confidence: 74%

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

et al. 2020

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Background: Weaning of patients from the mechanical ventilation remains one of the critical decisions in intensive care unit. This study aimed to evaluate the accuracy of thoracic fluid content (TFC) as a predictor of weaning outcome.Methods: An observational cohort study included 64 critically ill surgical patients who were eligible for extubation. Before initiating the spontaneous breathing trial, the TFC was measured using the electrical cardiometry technology. Patients were followed up after extubation and divided into successful weaning group and failed weaning group. Both groups were compared according to respiratory and cardiovascular parameters. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of TFC to predict weaning outcome. Results: The number of successfully weaned patients was 41/64 (64%). Twenty (31%) patients had impaired cardiac contractility, and of them, 13/20 (64%) patients were successfully extubated. Both groups, successful weaning group and failed weaning group, were comparable in most of baseline characteristics; however, the TFC was significantly higher in the failed weaning group compared to the successful weaning group. The area under the ROC curves (AUCs) showed moderate predictive ability for the TFC in predicting weaning failure (AUC [95% confidence interval] 0.69 [0.57-0.8], cutoff value > 50 kΩ −1 ), while the predictive ability of TFC was excellent in the subgroup of patients with ejection fraction < 40% (AUC [95% confidence interval 0.93 [0.72-1], cutoff value > 50 kΩ −1 ). Conclusions: Thoracic fluid content showed moderate ability for predicting weaning outcome in surgical critically ill patients. However, in the subgroup of patients with ejection fraction less than 40%, TFC above 50 kΩ −1 has an excellent ability to predict weaning failure.

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“…One study in critically ill children with respiratory failure and shock demonstrated that high TFC values correlate with pulmonary plethora and predicted patient outcomes ( 37 ). Another study in patients with heart failure suggested that TFC may identify patients at risk for decompensation ( 38 ). TFC measurements using EC have shown to be correlated with the presence of respiratory distress in infants ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

et al. 2022

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IntroductionThe assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON® monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock.Materials and MethodsWe conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student’s t-test to compare pre- and post-hemodynamic data and Mann–Whitney U-test to compare fluid responders and non-responders. P-Values < 0.05 were considered statistically significant.ResultsWe recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [−1.61 (−14.8, 0); p = 0.012], ΔDBP [−5.5 (−14.4, 8); p = 0.027], ΔMAP [−2.2 (−11, 2); p = 0.018], ΔSVR [−5.8 (−20, 5.2); p = 0.025], and ΔSTR [−8.39 (−21, 3); p = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); p = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness.ConclusionOur study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.

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Measurement of Thoracic Fluid Content in Heart Failure

Cited by 9 publications

References 20 publications

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

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