TFC (Thoracic Fluid Content): A New Parameter for Assessment of Changes in Chest Fluid Volume

Water, Joseph M. Van De; Mount, Bruce E.; Chandra, Kailash; Mitchell, Bernstein; Woodruff, Tajalyn A; Dalton, Martin L.

doi:10.1177/000313480507100116

Cited by 36 publications

(12 citation statements)

References 16 publications

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“…The ability of the noninvasive impedance technique to correctly assess CI and lung water has been demonstrated by many investigators. [10][11][12][19][20][21] ICG is used by more than 8,000 physicians nationwide, primarily in the office setting. Although not specifically tested in prospective fashion, our findings suggest that the noninvasive technique of ICG as a monitor of CI and TFC soon after the trauma patient is brought to the emergency room could be very helpful in management and resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic and Pulmonary Fluid Status in the Trauma Patient: Are We Slipping?

Veale

Morgan

Beatty

et al. 2005

The American Surgeon™

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Recent reports point to problems in the clinical assessment of the cardiopulmonary system in hemodynamically unstable patients, especially with the decreasing usage of pulmonary artery catheters. Our purpose was to evaluate the hypothesis that clinical judgment alone is inadequate for a reliable estimate of cardiopulmonary status in critically ill patients. Physician assessments (high, normal, or low) of cardiac index (CI) and thoracic fluid content (TFC) were made in 68 acute trauma cases and compared to the results obtained with impedance cardiography (ICG). Physician assessment using clinical judgment alone was correct only 42 per cent and 57 per cent, respectively, for CI and TFC. There was very little difference in heart rate (HR), blood pressure (BP), Glasgow Coma Score (GCS), and the number of injured systems between the incorrect and correct assessments of CI. However, the mean Injury Severity Score (ISS) was markedly higher for the incorrect than the correct CI values (18.8 ± 9.3 vs 14.2 ± 9.8, P = 0.0589). Thus, there is a need for an objective measurement of CI and TFC especially in the more severely injured patient. The inaccuracy of the clinical exam strongly suggests the need for a supplemental measurement, which the new and improved ICG monitor could provide.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic and Pulmonary Fluid Status in the Trauma Patient: Are We Slipping?

Veale

Morgan

Beatty

et al. 2005

The American Surgeon™

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“…TFC is an ICG derived measure providing information on the fluid content in the thorax. It was demonstrated that TFC is a reliable parameter for evaluating the hemodialysis and diuretics induced changes in preload (Zalewski et al 2013, Sanidas et al 2009, Graziani et al 2008, van De Water et al 2005, Peacock et al 2000. As a limitation of this measure, the changes in diaphragm position may also cause changes to electrical pathways of transthoracic sensing currents (Zhang et al 2016) introducing a potential error to TFC as a measure of preload in our study during HUT.…”

Section: Study Limitationsmentioning

confidence: 99%

Preejection Period as a Sympathetic Activity Index: a Role of Confounding Factors

Krohová

Czippelová²,

Turianiková³

et al. 2017

Physiol Res

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In previous studies, one of the systolic time intervals – preejection period (PEP) – was used as an index of sympathetic activity reflecting the cardiac contractility. However, PEP could be also influenced by several other cardiovascular variables including preload, afterload and diastolic blood pressure (DBP). The aim of this study was to assess the behavior of the PEP together with other potentially confounding cardiovascular system characteristics in healthy humans during mental and orthostatic stress (head-up tilt test – HUT). Forty-nine healthy volunteers (28 females, 21 males, mean age 18.6 years (SD=1.8 years)) participated in the study. We recorded finger arterial blood pressure by volume-clamp method (Finometer Pro, FMS, Netherlands), PEP, thoracic fluid content (TFC) – a measure of preload, and cardiac output (CO) by impedance cardiography (CardioScreen® 2000, Medis, Germany). Systemic vascular resistance (SVR) – a measure of afterload – was calculated as a ratio of mean arterial pressure and CO. We observed that during HUT, an expected decrease in TFC was accompanied by an increase of PEP, an increase of SVR and no significant change in DBP. During mental stress, we observed a decrease of PEP and an increase of TFC, SVR and DBP. Correlating a change in assessed measures (delta values) between mental stress and previous supine rest, we found that ΔPEP correlated negatively with ΔCO and positively with ΔSVR. In orthostasis, no significant correlation between ΔPEP and ΔDBP, ΔTFC, ΔCO, ΔMBP or ΔSVR was found. We conclude that despite an expected increase of sympathetic activity during both challenges, PEP behaved differently indicating an effect of other confounding factors. To interpret PEP values properly, we recommend simultaneously to measure other variables influencing this cardiovascular measure.

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“…Measurement of thoracic fluid content (TFC) using Bioimpedence is based on the theory that the thoracic cavity is an inhomogeneous electrical conductor (19). TFC is derived from the thoracic electrical base impedance (1/base impedance), which is dependent on thoracic intravascular and extravascular fluid content.…”

Section: Introductionmentioning

confidence: 99%

“…Larger TFC indicates a higher total thoracic fluid volume ( 20 ). Potential changes in TFC are directly proportional to total fluid changes ( 21 ). TFC measurement has been correlated with heart failure symptoms, net fluid balance, and chest radiographic findings of abnormal pulmonary fluid content in adults ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Thoracic Fluid Content (TFC) Measurement Using Impedance Cardiography Predicts Outcomes in Critically Ill Children

et al. 2021

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Objective: Conventional methods of fluid assessment in critically ill children are difficult and/or inaccurate. Impedance cardiography has capability of measuring thoracic fluid content (TFC). There is an insufficient literature reporting correlation between TFC and conventional methods of fluid balance and whether TFC predicts outcomes in critically ill children. We hypothesized that TFC correlates with indices of fluid balance [FIMO (Fluid Intake Minus Output) and AFIMO (Adjusted Fluid Intake Minus Output)] and is a predictor of outcomes in critically ill children.Design: Retrospective chart review.Setting: Pediatric intensive care unit of a tertiary care teaching hospital.Patients: Children <21 years, admitted to our Pediatric Intensive Care Unit (PICU) between July- November 2018 with acute respiratory failure and/or shock and who were monitored for fluid status using ICON® monitor.Interventions: None.Measurements and Main Results: We collected demographic information, data on daily and cumulative fluid balance (CFB), ventilator, PICU and hospital days, occurrence of multi-organ dysfunction syndrome (MODS), and mortality. We calculated AFIMO using insensible fluid loss. We analyzed data using correlation coefficient, chi-square test and multiple linear regression analysis. We analyzed a total 327 recordings of TFC, FIMO and AFIMO as daily records of fluid balance in 61 critically ill children during the study period. The initial TFC, FIMO, and AFIMO in ml [median (IQR)] were 30(23, 44), 300(268, 325), and 21.05(−171.3, 240.2), respectively. The peak TFC, FIMO, and AFIMO in ml were 36(26, 24), 322(286, 334), and 108.8(−143.6, 324.4) respectively. The initial CFB was 1134.2(325.6, 2774.4). TFC did not correlate well with FIMO or AFIMO (correlation coefficient of 0.02 and −0.03, respectively), but a significant proportion of patients with high TFC exhibited pulmonary plethora on x-ray chest (as defined by increased bronchovascular markings and/or presence of pleural effusion) (p = 0.015). The multiple linear regression analysis revealed that initial and peak TFC and peak and mean FIMO and AFIMO predicted outcomes (ventilator days, length of PICU, and hospital days) in critically ill children (p < 0.05).Conclusions: In our cohort of critically ill children with respiratory failure and/or shock, TFC did not correlate with conventional measures of fluid balance (FIMO/AFIMO), but a significant proportion of patients with high TFC had pulmonary plethora on chest x-ray. Both initial and peak TFC predicted outcomes in critically ill children.

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TFC (Thoracic Fluid Content): A New Parameter for Assessment of Changes in Chest Fluid Volume

Cited by 36 publications

References 16 publications

Hemodynamic and Pulmonary Fluid Status in the Trauma Patient: Are We Slipping?

Hemodynamic and Pulmonary Fluid Status in the Trauma Patient: Are We Slipping?

Preejection Period as a Sympathetic Activity Index: a Role of Confounding Factors

Thoracic Fluid Content (TFC) Measurement Using Impedance Cardiography Predicts Outcomes in Critically Ill Children

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