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

Abstract

Background The non-invasive analysis of body fluid composition with bio-electrical impedance analysis (BIA) provides additional information allowing for more persona-lised 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. 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.

Everything you need to know about deresuscitation

“…Use of a protocol including blood volume analysis with calculation of total circulating blood volume by albumin-marked isotope dilution technique resulted in a 66% reduction in mortality, 20% reduction in length of stay (LOS), 36 h earlier treatment decisions and change of treatment strategy in 44% (reduced fluid and diuretic administration in 50% of cases) [ 11 ]. A 5% increase in volume excess from baseline, measured by bio-electrical impedance analysis, was associated with increased mortality in a retrospective study of 101 critically ill patients [ 12 ]. Another study in 125 patients showed that the hydration status measured by bio-electrical impedance vector analysis (BIVA) seems to predict mortality risk in intensive care unit (ICU) patients better than the conventional method of fluid balance recording [ 13 ].…”

Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis

“…Third, we did not obtain data regarding fluid balance since our principal objective was to confirm that EVLW measured by TPTD is associated with a worse outcome. Fourth, we did not investigate EVLW as an adjunctive variable to other techniques, such as ultrasonography and bioelectrical impedance, to evaluate the fluid status [ 54 ]. Finally, we limited our search to articles published in English language and did not expand our search to clinical trial registry databases.…”

The Incidence of Radial Artery Occlusion in Critically Ill Patients after Cannulation with a Long Catheter

“…ICU and surgical patients often require advanced hemodynamic monitoring, which should be accurate and reliable. For some assessments, such as the patient’s fluid status, less invasive methods can be helpful [ 11 ]. However, other patients require more invasive monitoring, for which more precise and invasive tools are necessary.…”