Monitoring Hyperhydration during High-Dose Chemotherapy: Body Weight or Fluid Balance?

Abstract

Body weight and fluid input/output are usually monitored for checking fluid balance in case of intravenous hyperhydration during nephrotoxic chemotherapy. The reliability of measuring fluid input/output is uncertain. Moreover, this measurement is redundant, complex, labour-intensive and represents an occupational hazard for nurses and other health-care workers handling fluids or body excreta. In a prospective cohort study, we determined the concordance between body weight and fluid intake/output. We also examined the clinical consequences with respect to the safety of selecting only body weight measurement as a parameter for fluid overload. A total of 591 combined observations of fluid balances and body weights were collected. We observed a higher increase in body weight than in fluid balance. The Pearson correlation between fluid balance and body weight was relatively low (r = 0.28). With regard to the safety of measuring body weight only, we found 4 cases (0.6%) who might not have received furosemide if the fluid input/output had not been measured, without clinical consequences, however. After standardization, body weight can safely be used as the only parameter for monitoring fluid retention in case of hyperhydration during chemotherapy.

Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy

“…We chose to assess the weight-based method because this is a more practical and less labor-intensive approach compared with calculating cumulative fluid balance. In addition, studies have reported that methods utilizing fluid balance to determine fluid overload are often inaccurate and unreliable when compared with daily weights in ICU [32, 33] or general floor settings [34]. Fluid balance calculations are generally unable to account for insensible fluid losses, and so weight-based calculations could provide for improved control of this variable.…”

Cumulative fluid intake minus output is not associated with ventilator weaning duration or extubation outcomes in children*

“…Potential inaccuracies in the data (13,14) and the fact that two studies have shown no association between I-O data and daily weights (15,16) have led to the suggestion that intake and output data no longer be recorded (15). Although we cannot support or refute this recommendation without a clinical study to determine safety, we can recommend that other indicators of fluid balance such as daily weights, assessment of edema, central venous pressure measurements, and pulmonary edema on chest radiograph undergo rigorous testing to determine their association with important clinical outcomes.…”

Establishing an Evidence-Based Inpatient Medical Oncology Fluid Balance Measurement Policy

“…Twenty-four-hour intake and output consistently underestimated fluid change (r = 0.28) (Mank et al, 2003) when compared to daily weights (r = 0.29) (Wise et al, 2000). Error between measurements varied up to 36% among individual patients (Wise et al, 2000).…”

“…The studies illustrate insufficient evidence to support standard use of intake and output, but support obtaining daily weights for patients with fluid retention issues or those receiving chemotherapy (Daffurn et al, 1994;Kalisch, 2006;Mank et al, 2003;Wise et al, 2000). The studies illustrate insufficient evidence to support standard use of intake and output, but support obtaining daily weights for patients with fluid retention issues or those receiving chemotherapy (Daffurn et al, 1994;Kalisch, 2006;Mank et al, 2003;Wise et al, 2000).…”

“…The studies involved qualitative (Kalisch, 2006), quantitative (Mank, Semin-Goossens, Lelie, Bakker, & Vos, 2003;Wise, Mersch, Racioppi, Crosier, & Thompson, 2000), or mixed methods (Daffurn et al, 1994), with only one study involving patients with cancer as the primary sample (Mank et al, 2003). Structured interviews and observations of nursing practices (n = 105) for intake and output measurements and weights (Kalisch, 2006) or surveys (n = 143) on nursing perceptions of fluid balance records (Daffurn et al, 1994) produced similarities in identified barriers.…”