Bioimpedance Measured Volume Overload Predicts Adverse Outcomes in ICU Patients
CCCF ePoster library. Slobod D. Oct 4, 2017; 198130; 77
Douglas Slobod
Douglas Slobod
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Bioimpedance Measured Volume Overload Predicts Adverse Outcomes in ICU Patients

Slobod A, Douglas A1; Yao B, Han B2; Mardini C, Joëlle C3; Natkaniec D, Justina D4; Jayaraman E, Dev E5; Weber F, Catherine F6

1 Internal Medicine, McGill University Health Centre, Montreal, Quebec

2 Nephrology, McGill University Health Centre, Montreal, Quebec

3 Nephrology, McGill University Health Centre, Montreal, Quebec

4 Nephrology, McGill University Health Centre, Montreal, Quebec

5 Critical Care and Internal Medicine, McGill University Health Centre, Montreal, Quebec

6 Nephrology, McGill University Health Centre, Montreal, Quebec

Introduction: Indiscriminate fluid administration and attendant volume overload is associated with adverse outcomes in patients admitted to the ICU.  As the clinical assessment of volume status is poor with high inter-observer variability, there is urgent need for an objective, reproducible measure of volume status.  Bioelectrical impedance analysis (BIA) is a technology that provides a rapid, non-invasive measurement of TBW, ECW and ICW and thus may aid the physician in the clinical assessment of volume status.

Hypothesis: Higher ECW/TBW in mechanically ventilated ICU patients is associated with increased ventilator days, incidence of AKI requiring dialysis and in-hospital mortality at 28 days.

Methods: We included adult patients admitted to the Montreal General Hospital ICU February 2016-January 2017 who required mechanical ventilation within 24 hours of admission in a pilot study. Patients with a cardiac pacemaker or defibrillator, limb amputation and those on chronic dialysis were excluded. The BIA device was used to measure ECW/TBW on days 1, 3, 5 and 7.  Briefly, this device is attached to the hands and feet via 8 electrodes and the differential impedance, depending on tissue type and water content, to a low level of applied current is measured. The normal range of ECW/TBW is 36.0-39.0%. Patients discharged home before 28 days were assumed to be alive. 

Results: 36 patients were enrolled. Mean age was 62 years and 31% were female. Most patients were admitted from the emergency department or the operating room and the most common reason for admission was sepsis. Mean APACHE II score was 18.7, median ventilator days were 5 and median length of stay in ICU was 7 days. Overall, 6% of patients required dialysis and 22% died within 28 days. Day 1 ECW/TBW correlated with ventilator days (r=0.494).  Patients who died had a higher day 1 ECW/TBW (41.6% vs 40.4%, p-value 0.022) as did those who required dialysis (42.0% vs 40.6%, p-value <0.001).  Cumulative fluid balance and CVP did not correlate with the outcomes of this study.

Discussion: Bioimpedance technology objectively quantifies the degree of volume overload defined by ECW/TBW. Our results are consistent with existing evidence that volume overload leads to tissue edema and progressive organ dysfunction in critically ill patients. It was notable that approximately 20% of otherwise eligible patients could not be enrolled due to presence of medical equipment interfering with correct electrode placement. In addition, the BIA device requires accurate measurement of weight which is difficult to obtain in the ICU. 

Conclusion: ECW/TBW is associated with adverse outcomes in mechanically ventilated patients. BIA technology may be a useful adjunct to the clinical assessment of volume status, however, there are barriers to its routine use in an ICU population. Further study is needed to determine whether BIA guided interventions improve clinical outcomes.

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