Critically ill patients often experience hyperhydration and muscle wasting, which can worsen outcomes. This study evaluated the feasibility of using bioelectrical impedance vector analysis (BIVA) to monitor hydration and muscle mass and predict outcomes in COVID-19 patients with acute respiratory distress syndrome (ARDS), including those with extracorporeal membrane oxygenation (ECMO). The study compare fluid parameters derived from BIVA with cumulative fluid balance (CFB) and assess the prognostic value of the phase angle (PA) of BIVA against established markers such an APACHE II and serum presepsin. In this prospective, blinded observational study, 61 COVID-19 patients on invasive mechanical ventilation (IMV) were included. BIVA measurements were taken within 48 h of admission, then after 7 and 14 days. Data on demographics, fluid balance, and laboratory markers were collected. BIVA was shown to be feasible in critically ill patients, with a significant correlation between hyperhydration, defined by an elevated extracellular water to total body water ratio (ECW/TBW 0.56) and overhydration (OHY 6.9 l). Decreased PA (median 3.3°) was associated with increased mortality in non-ECMO patients. Unlike CFB, which lacked statistical significance, BIVA provided a more accurate assessment of hyperhydration (p=0.0050 for ECW/TBW and p=0.0402 for OHY). In conclusion, BIVA is a practical tool for monitoring hydration, but not muscle mass, in critically ill patients. Elevated hydration status and low PA measured by BIVA are effective predictors of mortality, although ECMO use can affect accuracy. ClinicalTrials.gov ID NCT04758676 (www.clinicaltrials.gov). Key words Bioelectrical impedance " Hyperhydration " Muscle mass " Critically ill patients " Mortality.

Institute of Physiology and Pathophysiology Faculty of Medicine University of Ostrava Czech Republic

Zobrazit více v PubMed

Vincent JL. Fluid management in the critically ill. Kidney Int. 2019;96:52–57. doi: 10.1016/j.kint.2018.11.047. PubMed DOI

Michael PW, Mythen MG, Gan TJ. Perioperative Fluid Management and Clinical Outcomes in Adults. Anaesth Analg. 2005;100:1093–1106. doi: 10.1213/01.ANE.0000148691.33690.AC. PubMed DOI

Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12:R74. doi: 10.1186/cc6916. PubMed DOI PMC

RENAL Replacement Therapy Study Investigators. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lee J, et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–1760. doi: 10.1097/CCM.0b013e318246b9c6. PubMed DOI

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, de Boisblanc B, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–2575. doi: 10.1056/NEJMoa062200. PubMed DOI

Magder S. Volume and its relationship to cardiac output and venous return. Crit Care. 2016;20:271. doi: 10.1186/s13054-016-1438-7. PubMed DOI PMC

De Backer D, Aissaoui N, Cecconi M, Chew MS, Denault A, Hajjar L, Hernandez G, et al. How can assessing hemodynamics help to assess volume status? Intensive Care Med. 2022;48:1482–1494. doi: 10.1007/s00134-022-06808-9. PubMed DOI PMC

Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–2008. doi: 10.1378/chest.121.6.2000. PubMed DOI

Perren A, Markmann M, Merlani G, Marone C, Merlani P. Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol. 2011;77:802–811. PubMed

Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989;261:884–888. doi: 10.1001/jama.1989.03420060100040. PubMed DOI

Preiser JC, Ichai C, Orban JC, Groeneveld ABJ. Metabolic response to stress of criticall illness. Br J Anaesth. 2014;113:945–954. doi: 10.1093/bja/aeu187. PubMed DOI

Kress JP, Hall JB. ICU-acquired weakness and recovery from criticall illness. N Engl J Med. 2014;370:1626–1635. doi: 10.1056/NEJMra1209390. PubMed DOI

Curz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyére O, Cederholm T, Cooper C, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169. PubMed DOI PMC

Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol. 2007;37:21–31. doi: 10.1007/s00247-006-0153-y. PubMed DOI PMC

Abramowitz MK, Hall CB, Amodu A, Sharma D, Androga L, Hawkins M. Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PLoS One. 2018;13:e0194697. doi: 10.1371/journal.pone.0194697. PubMed DOI PMC

Malbrain MLNG, Huygh J, Dabrowski W, De Waele JJ, Staelens A, Wauters J. The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: a bench-to-bedside review. Anaesthesiol Intensive Ther. 2014;46:381–391. doi: 10.5603/AIT.2014.0061. PubMed DOI

Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, Korth O, et al. Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas. 2006;27:921–933. doi: 10.1088/0967-3334/27/9/012. PubMed DOI

Khalil SF, Mohktar MS, Ibrahim F. The Theory and Fundamentals of Bioimpedance Analysis in Clinical Status Monitoring and Diagnosis of Diseases. Sensors. 2014;14:10895–10928. doi: 10.3390/s140610895. PubMed DOI PMC

Fujimoto K, Inage K, Eguchi Y, Orita S, Suzuki M, Kubota G, Sainoh T, et al. Use of bioelectrical impedance analysis for the measurement of appendicular skeletal muscle mass/whole fat mass and its relevance in assessing osteoporosis among patients with low back pain: a comparative analysis using dual x-ray absorptiometry. Asian Spine J. 2018;12:839–845. doi: 10.31616/asj.2018.12.5.839. PubMed DOI PMC

Cheng KY-K, Chow SK-H, Hung VW-Y, Wong CH-W, Wong RM-Y, Tsang CS-L, Kwok T, et al. Diagnosis of sarcopenia by evaluating skeletal muscle mass by adjusted bioimpedance analysis validated with dual-energy X-ray absorptiometry. J Cachexia Sarcopenia Muscle. 2021;12:2163–2173. doi: 10.1002/jcsm.12825. PubMed DOI PMC

Dzator S, Weerasekara I, Shields M, Haslam R, James D. Agreement Between Dual-Energy X-ray Absorptiometry and Bioelectric Impedance Analysis for Assessing Body Composition in Athletes: A Systematic Review and Meta-Analysis. Clin J Sport Med. 2023;33:557–568. doi: 10.1097/JSM.0000000000001136. PubMed DOI

Baumgartner RN, Chumlea WC, Roche AF. Bioelectrical impedance phase angle and body composition. Am J Clin Nutr. 1988;48:16–23. doi: 10.1093/ajcn/48.1.16. PubMed DOI

Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsch JF, Lammersfeld CA. Bioelectrical impedance phase ange as a prognostic indicator in advanced pancreatec cancer. Br J Nutr. 2004;92:957–962. doi: 10.1079/BJN20041292. PubMed DOI

Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch J, Lis GG. Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer. 2008;8:249. doi: 10.1186/1471-2407-8-249. PubMed DOI PMC

Káňová M, Dobiáš R, Liszková K, Frelich M, Ječmínková R, Kula R. Presepsin in the diagnostics of sepsis. Vnitr Lek. 2019;65:497–505. doi: 10.36290/vnl.2019.087. PubMed DOI

Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, Borggrefe M, et al. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care. 2014;18:507. doi: 10.1186/s13054-014-0507-z. PubMed DOI PMC

Silva MJA, Ribeiro LR, Gouveia MIM, Marcelino BDR, Santos CSD, Lima KVB, Lima LNGC. Hyperinflammatory Response in COVID-19: A Systematic Review. Viruses. 2023;15:553. doi: 10.3390/v15020553. PubMed DOI PMC

Cornejo-Pareja I, Vegas-Aguilar IM, Lukaski H, Talluri A, Bellido-Guerrero D, Tinahones FJ, García-Almeida JM. Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach. Nutrients. 2022;14:2726. doi: 10.3390/nu14132726. PubMed DOI PMC

Osuna-Padilla IA, Rodríguez-Moguel NC, Rodríguez-Llamazares S, Aguilar-Vargas A, Casas-Aparicio GA, Ríos-Ayala MA, Hernández-Cardenas CM. Low Phase Angle Is Associated with 60-Day Mortality in Critically Ill Patients with COVID-19. J Parenter Enter Nutr. 2021;46:828–835. doi: 10.1002/jpen.2236. PubMed DOI PMC

Lukaski HC, Vega Diaz N, Talluri A, Nescolarde L. Classification of Hydration in Clinical Conditions: Indirect and Direct Approaches Using Bioimpedance. Nutrients. 2019;11:809. doi: 10.3390/nu11040809. PubMed DOI PMC

Moonen HPFX, Van Zanteen ARH. Bioelectric impedance analysis for body composition meassurement and other potential clinical applications in critical illness. Curr Opin Crit Care. 2021;27:344–353. doi: 10.1097/MCC.0000000000000840. PubMed DOI PMC

Chamney PW, Wabel P, Moissl UM, Müller MJ, Bosy-Westphal A, Korth O, Fuller NJ. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr. 2007;85:80–89. doi: 10.1093/ajcn/85.1.80. PubMed DOI

Piccoli A, Codognotto M, Piasentin P, Naso A. Combined evaluation of nutrition and hydration in dialysis patients with bioelectrical impedance vector analysis (BIVA) Clin Nutr. 2014;33:673–677. doi: 10.1016/j.clnu.2013.08.007. PubMed DOI

Peacock WF., IV Use of bioimpedance vector analysis in critically ill and cardiorenal patients. Contrib Nephrol. 2010;165:226–235. doi: 10.1159/000313762. PubMed DOI

Finn PJ, Plank LD, Clark MA, Connolly AB, Hill GL. Progressive cellular dehydration and proteolysis in critically ill patients. Lancet. 1996;347:654–656. doi: 10.1016/S0140-6736(96)91204-0. PubMed DOI

Plank LD, Monk DN, Woollard GA, Hill GL. Evaluation of multifrequency bioimpedance spectroscopy for measurement of the extracellular water space in criticall ill patients. Appl Radiat Isot. 1998;49:481–483. doi: 10.1016/S0969-8043(97)00060-2. PubMed DOI

Rhee H, Jang KS, Shin MJ, Lee JW, Kim IY, Song SH, Lee DW, et al. Use of multifrequency bioimpedance analysis in male patients with acute kidney injury who are undergoing continuous veno-venous hemodiafiltration. PLoS One. 2015;10:e0133199. doi: 10.1371/journal.pone.0133199. PubMed DOI PMC

Dewitte A, Carles P, Joannès-Boyau O, Fleureau C, Roze H, Combe C, Outtara A. Bioelectrical impedance spectroscopy to estimate fluid balance in critically ill patients. J Clin Monit Comput. 2016;30:227–233. doi: 10.1007/s10877-015-9706-7. PubMed DOI

Yang SF, Tseng CM, Liu IF, Tsai SH, Kuo WS, Tsao TP. Clinical significance of bioimpedance spectroscopy in critically ill patients. J Intensive Care Med. 2019;34:495–502. doi: 10.1177/0885066617702591. PubMed DOI

Parrinello G, Paterna S, Di Pasquale P, Torres D, Fatta A, Mezzero M, Scaglione R, et al. The usefulness of bioelectrical impedance analysis in differentiating dyspnea due to decompensated heart failure. J Card Fail. 2008;14:676–686. doi: 10.1016/j.cardfail.2008.04.005. PubMed DOI

Di Somma S, Lalle I, Magrini L, Russo V, Navarin S, Castello L, Avanzi GC, Di Stasio E, et al. Additive diagnostic and prognostic value of bioelectrical impedance vector analysis (BIVA) to brain natriuretic peptide ‘grey-zone’ in patients with acute heart failure in the emergency department. Eur Heart J Acute Cardiovasc Care. 2014;3:167–175. doi: 10.1177/2048872614521756. PubMed DOI

Dabrowski W, Kotlinska-Hasiec E, Schneditz D, Zaluska W, Rzecki Z, De Keulenaer B, Malbrain ML. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol. 2014;82:41–50. doi: 10.5414/CN108015. PubMed DOI

Malbrain MLNG, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46:361–380. doi: 10.5603/AIT.2014.0060. PubMed DOI

Gulatava N, Tabagari N, Tabagari S. Bioelectrical impendance analysis of body composition in patients with chronic heart failure. Georgian Med News. 2021;315:94–98. PubMed

Wang Y, Gu Z. Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis. J Int Med Res. 2021;49:3000605211031063. doi: 10.1177/03000605211031063. PubMed DOI PMC

Park CS, Lee SE, Cho H-J, Kim Y-J, Kang H-J, Oh B-H, Lee H-Y. Body fluid status assessment by bio-impedance analysis in patients presenting to the emergency department with dyspnea. Korean J Intern Med. 2018;33:911–921. doi: 10.3904/kjim.2016.358. PubMed DOI PMC

Slobod D, Yao H, Mardini J, Natkaniec J, Correa JA, Jayaraman D, Weber CL. Bioimpedance-measured volume overload predicts longer duration of mechanical ventilation in intensive care unit patients. Can J Anesth. 2019;66:1458–1463. doi: 10.1007/s12630-019-01450-4. PubMed DOI

Tanaka S, Ando K, Kobayashi K, Seki T, Hamada T, Machino M, Ota K, et al. Low Bioelectrical Impedance Phase Angle Is a Significant Risk Factor for Frailty. Biomed Res Int. 2019;2019:6283153. doi: 10.1155/2019/6283153. PubMed DOI PMC

Looijaard WGPM, Stapel SN, Dekker IM, Rusticus H, Remmelzwaal S, Girbes ARJ, Weijs PJM, et al. Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography. Clin Nutr. 2020;39:1809–1817. doi: 10.1016/j.clnu.2019.07.020. PubMed DOI

Lorenzo I, Serra-Prat M, Yébenes JC. The Role of Water Homeostasis in Muscle Function and Frailty: A Review. Nutrients. 2019;11:1857. doi: 10.3390/nu11081857. PubMed DOI PMC

Bagshaw SM, Brophy PD, Cruz D, Ronco C. Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit Care. 2008;12:169. doi: 10.1186/cc6948. PubMed DOI PMC

Farokhi FR, Kalateh E, Shafaghi S, Schneider AG, Mortazavi SM, Jamaati H, Hashemian SMR. Applying bio-impedance vector analysis (BIVA) to adjust ultrafiltration rate in critically ill patients on continuous renal replacement therapy: a randomized controlled trial. J Crit Care. 2022;72:154146. doi: 10.1016/j.jcrc.2022.154146. PubMed DOI

Park CH, Koh HB, Lee JH, Jung H-Y, Ha J, Kim HW, Park JT, et al. Volume control strategy and patient survival in sepsis-associated acute kidney injury receiving continuous renal replacement therapy: a randomized controlled trial with secondary analysis. Sci Rep. 2024;14:14284. doi: 10.1038/s41598-024-64224-z. PubMed DOI PMC

Zobrazit více v PubMed

ClinicalTrials.gov
NCT04758676