Critical Care 2015, 19:290 doi:10.1186/s13054-015-1009-3
Jones S, et al
Assessment of fluid
status in critically ill patients is challenging. We aimed to assess the
feasibility and validity of bioelectrical impedance vector analysis (BIVA) as a
measure of hydration in critically ill patients.
Methods: We performed
twice-daily BIVA measurements and fluid balance calculations and recorded
physiological variables in mechanically ventilated patients within 24 h of
intensive care unit (ICU) admission for up to 5 days. Treating clinicians were
blinded to BIVA results.
Results: We performed 344 BIVA measurements in 61
patients. According to BIVA, 14 patients (23 %) were dehydrated, 22 (36 %) were
normally hydrated and 25 (41 %) were overhydrated upon ICU admission. Patients
with normal BIVA hydration were less sick, had fewer comorbidities and had less
deranged physiology than patients found to be dehydrated or overhydrated with
BIVA. Cumulative fluid balance increased in patients found to be dehydrated
with BIVA by a mean of 3.4±2.2 L, whereas in patients found to be overhydrated
with BIVA, it decreased by a mean of 4.5±6.9 L. In patients found to be
normally hydrated with BIVA, fluid balance remained unchanged. BIVA-defined
hydration increased with 1 L (median change 1.5 %, P =0.09) or 2 L (median
change 0.7 %, P =0.09) of calculated fluid gains. BIVA-defined hydration
decreased (median change −0.8 %, P =0.02) with a negative cumulative fluid
balance of >2 L. BIVA-defined hydration between first and last measurement
correlated with the corresponding change in fluid balance (ρ =0.25, P =0.05).
Conclusions: BIVA is feasible in critically ill patients. Its validity is
supported by the observed characteristics of patients with different degrees of
BIVA hydration upon admission and by different fluid management of such
patients by blinded clinicians. The sensitivity of repeated BIVA hydration
measurements to detect fluid accumulation or fluid balance changes ...
No comments:
Post a Comment