Segmental Blood Flow and Hemodynamic State of Lymphedematous and Nonlymphedematous Arms

Montgomery, Leslie D.; Dietrich, Mary S.; Armer, Jane M.; Stewart, Bob R.; Ridner, Sheila H.

doi:10.1089/lrb.2010.0012

Cited by 13 publications

(11 citation statements)

References 25 publications

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“…Hemodynamic redistribution of fluids between body segments and between the fluid compartments within those segments are of central importance to various fluid management procedures [4, 25] and disease states [20, 27, 28, 29, 30, 34]. Such fluid redistributions affect cardiovascular function, water balance and perhaps skeletal muscle function through physiological mechanisms that may be better understood with simultaneous characterization of both the extent and the rate of the inter-compartment redistributions.…”

Section: Introductionmentioning

confidence: 99%

Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures

Montgomery¹,

Gerth²,

Montgomery³

et al. 2013

Med Biol Eng Comput

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The bioimpedance spectroscopic (BIS) analytical algorithm described in this report allows for the non-invasive measurement of intravascular, interstitial, and intracellular volume changes during various fluid management procedures. The purpose of this study was to test clinical use feasibility and to demonstrate the validity of the BIS algorithm in computing compartmental volume shifts in human subjects undergoing fluid management treatment. Validation was performed using volume changes recorded from 20 end stage renal disease (ESRD) patients. The validation procedure involved mathematically deriving post hoc hematocrit profiles from the BIS data-generated fluid redistribution time profiles. These derived hematocrit profiles were then compared to serial hematocrit values measured simultaneously by a CritLine® monitor during 60 routine hemodialysis (HD) sessions. Regression and Bland Altman analyses confirm that the BIS algorithm can be used to reliably derive the continuous and real time rates of change of the compartmental fluid volumes. Regression results yielded a R2 > 0.99 between the two measures of hematocrit at different times during dialysis. The slopes of the regression equations at the different times were nearly identical, demonstrating an almost one to one correspondence between the BIS and CritLine® hematocrits. Bland Altman analyses show that the BIS algorithm can be used interchangeably with the CritLine® monitor for the measurement of hematocrit. The present study demonstrates for the first time that BIS can provide real-time continuous measurements of compartmental intravascular, interstitial and intracellular fluid volume changes during fluid management procedures when used in conjunction with this new algorithm.

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Section: Introductionmentioning

confidence: 99%

Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures

Montgomery¹,

Gerth²,

Montgomery³

et al. 2013

Med Biol Eng Comput

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“…The venous filling index can also be elevated by increased arterial inflow. 6 Arterial inflow in limbs with lymphedema was reportedly increased [7][8][9] or unchanged. 10,11 Even if the increase is due to chronic low grade inflammation or excess fat accumulation, 12 the impact on the venous filling index should be limited compared to that derived from axial GSVR, as Shiraishi reported, 13 and as verified in the current study.…”

Section: Discussionmentioning

confidence: 99%

Venous hemodynamics assessed with air plethysmography in legs with lymphedema

et al. 2018

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This study was conducted to identify specific abnormalities using the results from air plethysmography in legs with lymphedema. A routine air plethysmography exercise protocol was performed in 31 patients with unilateral leg lymphedema, and the results were compared with those of 53 patients with unilateral great saphenous vein reflux and 15 normal subjects. The venous filling index in legs with lymphedema (2.1 ± 1.2 mL/sec) was smaller than in legs with great saphenous vein reflux (6.4 ± 4.1 mL/sec, p < 0.05), but was not different from that in normal legs (1.9 ± 1.2 mL/sec). The ejection fraction was similar in all groups. The residual volume fraction in legs with lymphedema (35 ± 32%) was larger than that in normal subjects (13 ± 23%, p < 0.05), but was not significantly different from that in the contralateral leg of the lymphedema patients (32 ± 27%). In conclusion, we found no specific air plethysmography findings in uncomplicated lymphedema.

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“…The application and capability of the BIS when operated in the IPG mode to quantify segmental blood flow and hemodynamics is described elsewhere (4,6). Details of the analytical algorithm used to derive individual fluid compartment volumes from the impedance spectroscopic recordings are given in previous articles [30][31][32].…”

Section: Applicationmentioning

confidence: 99%

“…Hemodynamic redistribution of fluids between body segments and between the intracellular and extracellular compartments within those segments are often of central importance to various fluid management procedures [1,2], disease states [3][4][5][6] and orthostatic dysfunction [7,8]. These redistributions affect cardiovascular function, water balance and perhaps skeletal muscle function through physiological mechanisms that may be better understood with simultaneous characterization of both the extent and rate of the intercompartment redistributions that take place during fluid management therapy.…”

Section: Introductionmentioning

confidence: 99%

A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis

Montgomery¹,

Montgomery²,

Gerth³

et al. 2017

Journal of Electrical Bioimpedance

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This paper describes a new combined impedance plethysmographic (IPG) and electrical bioimpedance spectroscopic (BIS) instrument and software that allows noninvasive real-time measurement of segmental blood flow and changes in intracellular, interstitial, and intravascular volumes during various fluid management procedures. The impedance device can be operated either as a fixed frequency IPG for the quantification of segmental blood flow and hemodynamics or as a multi-frequency BIS for the recording of intracellular and extracellular resistances at 40 discrete input frequencies. The extracellular volume is then deconvoluted to obtain its intra-vascular and interstitial component volumes as functions of elapsed time. The purpose of this paper is to describe this instrumentation and to demonstrate the information that can be obtained by using it to monitor segmental compartment volumes and circulatory responses of end stage renal disease patients during acute hemodialysis. Such information may prove valuable in the diagnosis and management of rapid changes in the body fluid balance and various clinical treatments.

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Segmental Blood Flow and Hemodynamic State of Lymphedematous and Nonlymphedematous Arms

Abstract: Both arterial and venous components may be altered in the lymphedema-affected arms when compared to healthy normal arms and contralateral arms in the breast cancer survivors.

Cited by 13 publications

References 25 publications

Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures

Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures

Venous hemodynamics assessed with air plethysmography in legs with lymphedema

A system to monitor segmental intracellular, interstitial, and intravascular volume and circulatory changes during acute hemodialysis

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