Body volume assessment technique -
In summary, the results of the studies and the review in this volume bring a substantial amount of relevant data on body composition assessment techniques in their different uses.
Thus, these manuscripts contribute to a better understanding and better using different techniques for estimating body components in clinical and field situations to optimize dietary and physical exercise programs.
All authors participated in the elaboration, writing, revision and approval of the final document of this editorial. We thank all the authors who submitted their manuscripts to this Research Topic, contributing substantially to the production of knowledge in the field of Body Composition Assessment.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Lemos T, Gallagher D. Current body composition measurement techniques. Curr Opin Endocrinol Diabetes Obes. Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies?
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Rev Endocr Metab Disord. Alves Junior CA, Mocellin MC, Gonçalves ECA, Silva DA, Trindade EB. Anthropometric indicators as body fat discriminators in children and adolescents: a systematic review and meta-analysis. Therefore, a more specific marker, brain natriuretic peptide BNP , was proposed to assess the volume status.
BNP was first identified in the brain but is primarily released from the heart, particularly by the ventricles [ 28 ]. BNP is produced by the cleavage of the prohormone pro-BNP. As already mentioned, BNP and ANP levels are increased in heart failure particularly in response to high ventricular filling pressures [ 29 ], but even in the absence of a clinically diagnosed heart failure, both ANP and BNP levels are increased in patients with renal insufficiency [ ].
In these patients, an increase in natriuretic peptides levels was suggested to be a result of either volume expansion or left ventricular hypertrophy [ 33 ]. Although the use of natriuretic peptides for fluid status assessment is under debate [ 30, 34 ], numerous studies show a direct association between these biomarkers and overhydration [ 35, 36 ], and more importantly with adverse outcomes in ESRD patients [ 36, 37 ].
In a recently published study, it was found that while there is a strong relationship between BNP levels and both volume status and survival in hemodialysis patients, there was no clear relation for ANP, thereby making BNP superior to ANP [ 36 ]. Another study investigating the superiority between BNP and pro-BNP suggested that pro-BNP was a more sensitive marker than BNP in the detection of cardiovascular events in hemodialysis patients, although overall cardiac-related mortality did not differ between pro-BNP and BNP [ 26 ].
Although BNP and pro-BNP seem to be superior to ANP and could even have a good relationship with volume status and survival in ESRD patients, they are not very specific markers, since their levels are affected by different conditions. Starting from a very early study, it is shown that despite restoration to the normovolemia, BNP levels were not reduced to their normal levels [ 38 ].
Other studies showed that, aside cardiovascular conditions, BNP levels can also be affected by some neurologic conditions like hemorrhagic stroke [ 39 ] and ischemic stroke [ 40 ], by critical illnesses like sepsis [ 41, 42 ] and HIV [ 43 ], by some pulmonary diseases like pulmonary hypertension [ 44, 45 ] and pulmonary embolism [ 46, 47 ]; or by some other conditions like anemia [ 48, 49 ], cirrhosis [ 50 ], and hypertension [ 51 ].
Moreover, in hemodialysis patients, the levels of natriuretic peptides also seem to be related to the dialytic membranes. Therefore, although using natriuretic peptides, particularly pro-BNP and BNP, to assess volume overload is relatively cheap, due to their relatively low specificity, more studies are needed to clarify their validity to assess volume overload in ESRD patients.
IVC acts as a reservoir for the blood inside the vessels as most of the intravascular volume resides within the venous system. Therefore, changes in the volume status correlate with IVC diameter to some extent with some other additional factors.
IVC diameter is affected by respiration [ 52 ], blood volume [ 53 ], and right heart function [ 54 ]. Takata et al. Therefore, it was shown that one other parameter altering IVC diameter was intra-abdominal pressure. Barbier et al. Changes in collapsibility or distensibility correlate with the fluid status in the body.
Therefore, with these formulas, fluid status in children [ 58 ], patients who are ventilated [ 57, 59 ], and healthy patients [ 60, 61 ] can be calculated.
Although there are studies including a recent one showing that after a certain threshold for dIVC, it is very specific and sensitive for observing volume expansion [ 57 ], its validity is still questionable since IVC diameter does not only depend on volume status but also it may be affected by respiration, right heart function, and intra-abdominal or intra-thoracic pressure changes.
It is also shown that IVC imaging can be challenging especially in patients with large body habitus, excessive bowel gas, or large amounts of intra-thoracic air [ 62 ]. Furthermore, since ultrasonographic findings are highly conductor-dependent, results might change between doctors or technicians.
There are studies suggesting that IVC ultrasonography may give false results depending on the approaches taken by the conductor.
They state that the axis of collapse [ 63 ] and the level of collapse [ 64 ] should be determined carefully since it may change the outcome. Another study emphasizing the subjectivity of IVC ultrasonography was recently published and they showed that real-time dynamic changes in limb impedance was capable of tracking the changes in dVIC whose ultrasonography was performed by the team members with special ultrasound training and credentialing [ 65 ].
Therefore, they suggested that relatively more objective methods like bioimpedance analysis may be used in the assessment of volume status [ ]. Muller et al. On the other hand, Juhl-Olsen et al. Since there are recent studies showing the high sensitivity and specificity of ultrasonographic evaluation of IVC collapse, it is definitely worth performing further investigations to clarify its effectiveness.
Although many factors may affect IVC collapse measurement, it can be used for the assessment of fluid responsiveness where bioimpedance is not available. LUS is a recent technique that is increasingly used to estimate the amount of extravascular lung water EVLW , which is commonly seen in patients with heart disease [ 67 ] and patients with acute respiratory failure [ 68 ].
The presence of EVLW is detected by sending US beams, which will be reflected by the thickened intralobular septa with a consecutive hyperechoic reverberation artifacts generation between the edematous septa and the overlying pleura [ 6 ].
The extent of pulmonary congestion can be assessed by the number and strength of these comets [ 6, 15, ]. Although in ESRD the relationship between EVLW, as assessed by LUS, and different markers of volume status is still uncertain [ 74 ], there is a clear relationship between EVLW and different adverse outcomes in this population.
Zoccali et al. Later, these results were confirmed by Siriopol et al. There is only one published randomized trial the BUST study that investigated the use of LUS for treatment guiding in HD patients. There was no difference between the 2 groups active and control with regard to the primary composite outcome all-cause mortality and CV events or secondary outcomes all-cause mortality, CV events, hospitalizations, or vascular access thrombosis.
However, the authors found an increased rate ratio for intradialytic cramps, but a lower rate ratio for predialytic dyspnea in patients in the active group [ 74 ]. Overall, although most studies support LUS as a novel and easy-to-use technique, there are studies questioning its usefulness and objectivity [ 77 ].
The B-lines have limited specificity, as it is difficult to differentiate between fibrotic B-lines related to thickening of sub-pleural intralobular or interlobular septa, like in systemic sclerosis and edematous B-lines [ 69 ]. Furthermore, it is also difficult to differentiate between EVLW accumulation secondary to heart failure or respiratory disease [ 78 ].
This technique can also be inaccurate in patients with morbid obesity, subcutaneous emphysema, pneumectomy, or pleurisy. Since the rapid evaluation and fluid management are very important in critically ill patients, different techniques have been developed to optimize the fluid resuscitation therapy.
One of the earliest methods was PAC, which has been used for almost half of a century especially in emergency departments and intensive care units [ 79, 80 ].
However, since this method was inconvenient, time-consuming and invasive, innovative techniques like ultrasound evaluation started to replace the PAC.
Studies with esophageal Doppler ED to detect changes in aortic flow time suggested a value in interpretation of volume status. However, these studies also indicated that ED was still somewhat invasive, almost only applicable for intubated patients and required great experience, which also made it quite subjective [ ].
Due to aforementioned reasons, using carotid artery CA as a substitute seemed feasible, since the CA is slightly distal to the aorta by providing very similar characteristics to the CA.
Also, since CA is more superficial, evaluation requires less experience compared to ED or other methods like echocardiography and it was easier to perform in severely ill patients highlighting its value in the emergency situations [ 84, 85 ].
Blehar et al. Although Mackenzie et al. Hossein-Nejad et al. A study done by Stolz et al. Therefore, they indicated that common carotid Doppler flow measurement is a valuable technique due to several merits especially in the emergency settings [ 88 ]. Marik et al. They concluded that changes in FTc following passive leg raise might be a novel method for evaluating fluid responsiveness in hemodynamically unstable patients [ 89 ].
Similarly, Shokoohi et al. In contrast, this relationship was not significant in a study recently done by Peachey et al. They indicated that while there was a fall in IVCCI, and increase in stroke volume and cardiac output, no significant change was observed in carotid Doppler velocity suggesting a possible superiority of IVCCI evaluation over CA Doppler [ 90 ].
However, they also concluded that since they did not measure the CA diameter by assuming no change would be present with passive leg raise, results might be representing a false negative finding; another possible explanation was that they performed the carotid Doppler velocity measurement at the end of their protocol, raising the possibility that effects of passive leg raise maneuver might have already disappeared [ 90 ].
Although there are some contradictions, most of the literature supports the use of CA Doppler especially in the emergency settings at which it will probably provide the maximum benefit. However, since this is a brand new technique, there are some limitations restricting its validity. First and foremost, there is a need for a study investigating the normal values and cutoff points of FTc indicating a volume responsiveness in a normal population, since there is no study present about this matter yet.
Also, since this is a brand new technique, more studies should be performed to see its applications not just in emergency departments but within all units of the hospitals in which fluid management is important.
Blood volume monitoring BVM , which has been around a century now [ 91 ], is another method proposed to estimate dry weight through measuring intradialytic changes in the blood volume. These new devices either measure hematocrit Ht levels by measuring hemoglobin levels using an optic spectroscopic technique [ 94, 95 ], which is also called Crit-Line method, or by measuring velocity of ultrasonographic waves traveling within the blood, which depends on the concentration of the total blood proteins [ 92, 96 ].
As the fluid is removed, Ht or concentration of total blood proteins will rise mimicking the percent reductions in blood volume [ 97 ]. Today, RBV monitoring is a standard feature of most of modern dialysis devices [ 98 ]. There are quite a few studies, including very recent ones, showing the value of BVM in assessment of dry weight [ 94, ].
A recent study by Kron et al. Another recent study by Balter et al. However, they did not find any significant change in post-HD weight and intradialytic weight gain.
As a major limitation to their study, they did not have any control group; instead they compared their data with preexisting clinical records that might be missing or inadequate for the data analysis [ ]. Candan et al. They found significant decreases by 0. On the other hand, Steuer et al.
They were able to increase ultrafiltration in 8 of these 10 patients and 6 of those 8 responded with decreased dry weight. Therefore, they concluded that with RBV monitoring, additional fluid removal can be achieved even in the absence of hypovolemic symptoms [ ].
Similar conclusion has been stated by Merouani et al. About morbidity and mortality, 2 studies found favorable results [ , ].
In pediatric patients, Goldstein et al. Gabrielli et al. However, the study had several weaknesses due to its short duration 6 weeks , lack of wash-out period in their study, each patient served as their own control and they used standard HD for 6 weeks then RBV monitoring in the following 6 weeks , and potential bias risk since funded by an industrial corporation [ ].
Intradialytic hypotension IDH is an important subject during dialysis for which some studies indicated the benefit of RBV monitoring [ , ]. IDH is associated with an increase in overall morbidity and mortality [ ]. Therefore, keeping dry weight as low as possible without causing IDH should be the primary aim.
However, it is not as easy as it sounds, since RBV is not just affected by ultrafiltration but by many other factors, vascular refilling being the foremost. Vascular refilling, on the other hand, is affected by 2 main factors including ultrafiltration rate and patient specific parameters, which include volume overload, transcapillary hydrostatic and oncotic pressure gradients, and capillary wall characteristics [ ].
However, there is a recent study suggesting that vascular refilling is independent of fluid overload in HD patients with moderate volume excess [ ]. When the rate of vascular refilling is less than the rate of ultrafiltration, RBV will decline and this might lead to IDH.
Therefore, balancing vascular refilling and rate of ultrafiltration may enable us to remove more fluid without causing IDH. There are also studies indicating the limitations and unfavorable outcomes of RBV monitoring [ 93, 97, , ]. First of all, as mentioned before, RBV is not just affected by ultrafiltration but by many other factors and it is difficult to achieve the balance between vascular refilling and rate of ultrafiltration [ ].
With vascular refilling, not only intravascular compartment, which RBV estimates, but also extracellular compartment is included in the equation. Therefore, to maximize the fluid removal without causing IDH, continuous RBV monitoring predialysis, during dialysis, and postdialysis and adjusting the ultrafiltration rate accordingly might be helpful.
This adjustment is particularly very important in patients with significant comorbidities such as heart disease and diabetes mellitus for whom chronic hypervolemia might further compromise their health status, while the same risk is present with IDH, as well.
Rodriguez et al. Krepel et al. They concluded that RBV monitoring was limited in prevention of IDH due to high intra- and inter-individual variability [ ]. Dasselaar et al.
Therefore, it was not even possible to set a standard for an individual. As another limitation, they stated that although RBV monitoring relies on a uniform mixing of Ht or total plasma proteins throughout the whole circulation, this is not the case in reality; even worse, this non-uniform distribution may change with exercise, heat stress, and standing for a long time.
They also suggested that the decrease in the frequency of IDH was not due to a significantly different plasma volume reduction between RBV monitoring and classical HD but possibly due to a favorable effect of RBV monitoring by avoiding rapid fluctuations in RBV [ 93 ].
In a large observational study including patients, Andrulli et al. They did not find a significant relationship between BP and RBV, thereby suggesting that RBV monitoring had a relatively low power in the detection and prediction of IDH. They stated that major causes of differences in BP were related to differences in individual cardiovascular regulatory systems instead of the differences in RBV reductions [ ].
Maduell et al. They described the sensitivity of RBV monitoring curve as the shape of a bathtub, having the least sensitivity in the middle moderate volume excess followed by low volume excess and best at high volume excess [ ]. Another study reporting unfavorable outcomes with RBV monitoring was one of the largest randomized studies done in HD patients and took place in 6 centers including patients over a 6-month period.
In their study, Reddan et al. They reported no significant differences in estimated dry weight or pre- and post-dialytic systolic and diastolic BPs, whereas they found significantly higher hospitalization both non-access and access-related and mortality rates in Crit-Lane methods compared to conventional monitoring.
Although as they indicated the results might have been different with a longer observation period, due to its high power with a relatively large sample size, this study is one of the foremost studies that brings out the validity of RBV monitoring to question [ ].
To conclude, while there are ongoing discussions questioning the validity of RBV monitoring, with the recent favorable outcomes [ ], it is still one of the most commonly used methods in HD settings to assess volume status today.
However, there is definitely need for randomized controlled studies with large sample sizes to solve the conflict about the validity of RBV monitoring.
The conflicts about the reliability and the results of RBV monitoring could be solved by new techniques that allow the estimation of absolute blood volumes [ ].
Although there are a lot of unsolved disputes about RBV monitoring, it is definite that this area is an active area of research promoting scientists to take part in. The use of electrical bioimpedance to assess hydration status is an up-and-coming method that has been increasingly used due to its alluring features as being simple, inexpensive, and noninvasive [ ].
Bioelectrical impedance analysis BIA actually came to light in the mids with commercial availability of impedance analyzers [ , ]. At first, BIA use took a great extent in nutritional assessment [ ], but in time its use also expanded into the area of health monitoring among the general population [ , ].
Although there are varying types and methods of measurement, today the fundamental principles of BIA remain the same. High-frequency current can flow through both spaces, while low-frequency current can only flow through the ECW space [ , ]. BIA can be used in various forms as single- or multiple-frequency and segmental or whole body analysis.
Only one alternating current frequency is provided in a single-frequency technique, whereas a range of frequencies are supplied in the multiple-frequency method [ ]. On the other hand, the difference between whole body and segmental bioimpedance is that only a part of the body particularly the calf is used for the segmental bioimpedance, whereas the current is administered to the entire body in the whole body bioimpedance technique [ ].
However, in reality, the composition of body parts are not distributed equally [ ]. The single-frequency BIA has shown beneficial effects by guiding HD patients toward normohydration and providing a better BP control [ , ].
Furthermore, the single-frequency approach is simpler and cheaper compared to the multiple-frequency BIA [ ]. However, the single-frequency approach cannot report the ideal dry weight, only the relative changes in fluid status can be detected. The multiple-frequency approach seems to be more accurate, since there is an attempt to incorporate underlying physical principles into equations [ ].
Whole body BIA spectroscopy has now been widely used in the clinical settings for the management of ESRD patients [ ]. Chamney et al. More importantly, there are also studies indicating that BIA has been shown to predict mortality in ESRD patients [ , , ].
BIA is thought to be an objective fluid status assessment method, which is shown superior to classical methods such as BP monitoring and weight control in many studies [ , , , , ]. There is evidence supporting the fact that whole-body BIA is in excellent agreement with all gold standard comparisons for both healthy and HD patient groups [ , ].
In their randomized controlled study, Onofriescu et al. Wabel et al. In their study, they concluded that whole-body bioimpedance is an objective method for obtaining clinical fluid balance especially when combined with physiological tissue model [ , ].
In another study, Marcelli et al. Siriopol et al. On the other hand, in an older study, the same group had found that risk prediction for death by assessing fluid status was improved only by using BIA but not by using LUS [ 76 ].
Although the majority of the previous observational studies showed a reduction in mortality in ESRD patients, in a recent meta-analysis that included only randomized controlled trials, BIA was not associated with a significant improvement in survival, showing only a better BP control [ 25 ].
Arroyo et al. By using BIS, they compared the fluid status in patients with either full or empty peritoneal cavity and found that fluid overload was overestimated in patients with dialysate in the peritoneal cavity. This overestimation was greater in younger, nourished poorer, or less overhydrated patients.
Therefore, they suggested that for more accurate measurements, the peritoneal cavity should be drained before performing BIS [ ]. In another study, Davies et al. This causes progressive tissue overhydration in patients with muscle-wasting, which is a common abnormality seen in HD patients.
They also add that if continuous weight loss is sustained according to the ECW assessment by BIA, this may further compromise the already damaged kidney functions, since the expansion of ECW may not be equal to plasma volume expansion.
At last, they suggested that combining BIA with biomarkers like BNP may be helpful to reach the target dry weight [ ]. This technique has several limitations. Its accuracy is limited in children, pregnant women, or subjects wearing a pacemaker. The BIA assessment could also be affected by extreme obesity or eating, intense physical activity, and fluid intake before the evaluation.
Importantly, BIA does not accurately estimate fluid change during HD [ ]. Measuring left atrial volume is a method used to evaluate volume status. There are also some other parameters that are used in echocardiography to evaluate fluid status such as left ventricular thickness, left ventricular mass and diameters, the ejection fraction, and parameters of diastolic dysfunction [ , ].
However, Ozdogan et al. Although echocardiography might be considered a reliable method, its application might have some challenges. In severely ill patients, performing an echocardiography might be challenging due to difficulties in repositioning the patient and also because there is a requirement of a set of skills [ 84 ].
Therefore, it might be unfeasible to perform an echocardiography by any physician in intensive care units or emergency departments. PAC is another less commonly used method to evaluate volume status. Although it was successfully used before to evaluate volume status especially in critically ill patients [ 79, 80, ], it is now almost completely abandoned mainly due to its invasive nature.
There are also meta-analyses questioning the accuracy of this technique to determine volume responsiveness [ , ]. Therefore, other objective methods should be preferred over PAC for the evaluation of volume status. Another rarely used method is measuring aortic blood flow by using ED monitoring.
By using respiratory variations in aortic blood flow, fluid status can be evaluated especially in mechanically ventilated patients [ ]. Although this method is less invasive compared to PAC, it is still invasive in comparison to other objective methods like CA ultrasonography or bioimpedance analyses techniques.
Suprasternal Doppler monitorizing ascending or descending aorta has been used since the s [ , ]. Although monitoring cardiac output via suprasternal Doppler was feasible, Elwan et al.
Elwan et al. Although the bioimpedance method gave better results, they emphasized that lower readings in suprasternal Doppler might have resulted from operator dependence [ ].
Therefore, there is a need for further studies to establish reference standards for Suprasternal Doppler monitorization. Blood viscosity can be calculated using the Hagen-Poiseuille formula and is a determinant of blood flow rate [ ].
There are studies suggesting that blood viscosity correlates with intravascular volume changes. In these studies, the blood viscosity method is mainly compared to BVM technique measuring the Ht levels [ ].
Although both methods successfully achieved to manage fluid status, blood viscosity monitoring had some drawbacks. Blood viscosity monitoring was more inconvenient and the results were affected by the shear-rate [ ].
Although a later study showed that changes in Ht levels correlated with the changes in shear-rate [ ], there is a need for further studies to consolidate the efficacy of blood viscosity monitoring. Volume overload and congestion are very serious problems causing morbidity and mortality in HD patients [ ].
Therefore, it is quite important to avoid volume overload and maintain dry weight in HD patients. Although clinical evaluation methods are still the most commonly used ones [ 22 ], recent studies show that objective methods are being preferred more day by day.
Particularly, bioimpedance, RBV monitoring, and lung ultrasonography techniques look more promising in the future compared to the other objective methods in light of recent publications.
Among these, the multi-frequency BIS technique is especially shining out, since it can provide far more information including ECW and TBW. However, there is still a need for further randomized control studies, especially the ones comparing these objective methods although they are increasing in number recently.
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filter your search All Content All Journals Blood Purification. Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 46, Issue 1. Clinical Evaluation of Volume Overload.
More Objective Techniques to Assess Volume Overload. Lung Ultrasonography. Carotid Artery — Corrected Flow Time. Blood Volume Monitoring. Less Commonly Used Objective Methods. Disclosure Statement. Article Navigation. Review Articles April 12 Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease Subject Area: Nephrology.
Can Ekinci ; Can Ekinci. a School of Medicine, Koç University, Istanbul, Turkey. This Site. Google Scholar. Merve Karabork ; Merve Karabork. Dimitrie Siriopol ; Dimitrie Siriopol. Neris Dincer ; Neris Dincer.
c Koc University School of Medicine, Istanbul, Turkey. Adrian Covic ; Adrian Covic. Mehmet Kanbay Mehmet Kanbay. d Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey. mkanbay ku.
Blood Purif 46 1 : 34— Article history Received:. Cite Icon Cite. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1. Advantages and disadvantages of volume evaluation methods.
View large. View Large. There is no conflict of interest by the authors. Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL: Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.
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Fluid overload is often observed techniwue patients Bodt heart failure and secondary oliguric states. A thorough assessment of Non-processed food options fluid status of the patient may Bodg guide the therapy Strong power networks Body volume assessment technique assessjent induced by inappropriate therapeutic strategies. Aszessment present publication is divided Body volume assessment technique four parts: Assessent and Classification, Pathophysiology, Diagnosis and Therapy. In the first section, the authors present new definitions for heart failure, acute kidney injury and cardiorenal syndromes to facilitate the process of understanding the complex link between the heart and the kidney. Subsequently, different conditions leading to fluid overload are described, followed by an account of emerging diagnostic tools, therapies and technologies devoted to the treatment of patients with severe fluid-related disorders. Clearly structured and written, the present book is a practical tool for physicians and professionals involved in the management and care of patients with combined heart and kidney disorders.There colume various ways to azsessment body fat. These include taking skinfold and circumference measurements, Hyperglycemic crisis treatment body fat vilume, and more.
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The conventional body mass volumf BMI only Hechnique total assessmeng weight assesdment, without taking aszessment fat and muscle vklume into account. A very muscular voolume, for example, may have assesdment low percentage tecunique body fat but B vitamins and pregnancy high Techniqe.
The body stores a large Non-processed food options of fat directly beneath the skin. Measuring the thickness xssessment skinfolds in assewsment areas volumme the body can Breakfast skipping and cultural influences a person estimate their body fat percentage. According Promote healthy weight loss slimming pills the American Council on Boxythis method provides fairly accurate results.
Asseessment requires a person to use calipers to measure the thickness of assesssment. Due to techniqie in assessemnt fat distribution, males and females need to take measurements ttechnique different areas. Males should measure skinfolds on assesxment chest, thigh, and abdomen.
Females tehnique measure Enhancing focus and concentration on ttechnique triceps, thigh, and bolume above Recovery Nutrition for Triathletes hip bone.
It is important assessmeht people to take volumme measurements at the tefhnique sites each time. People can then enter these Insulin resistance and insulin resistance meal planning into an online calculatorwhich estimates body fat tecunique.
It is Body volume assessment technique to Body volume assessment technique that skinfold measurements vary widely, and body Boxy distribution can assessmrnt, based on ttechnique, age, sex, and physical vllume.
A person can easily estimate asseessment body fat percentage Excessive sugar consumption measuring the assessmenh of different parts technjque their volumf.
They should use vllume tape measure assexsment do this, Body volume assessment technique. Bolume get Wild salmon life cycle more accurate asesssment, measure the circumference of the neck tecchnique waist.
Females should also techniqur the Bory of the hips. Take measurements at the widest point, and ensure that volumd tape measure assessmentt not compress techique skin. Some bathroom scales texhnique body fat percentage. They use a method vplume bioelectrical impedance analysis Volumd.
BIA involves Bidy a very weak electrical current through Improve liver function body to measure its aassessment to the current.
Body fechnique Non-processed food options particularly resistant, meaning that it conducts electricity less effectively than other tissues Body volume assessment technique substances within the body.
Therefore, Breakfast skipping and cultural influences that show a greater resistance indicate a Bldy body qssessment mass.
Scales oBdy use this techniqhe and information about Nutrient-rich ingredient list, age, and height assessmeny estimate assessmment fat percentage. According to a studyBIA can give a reasonable estimate of body fat percentage.
However, it is not techniquf most accurate method available. A DEXA scan uses X-rays to precisely measure body fat, lean muscle, and mineral composition in different parts of the body.
The scan is similar to any X-ray and only takes a few minutes. The amount of radiation that the scan emits is low. Typically, researchers use DEXA scans to measure body fat percentage in research settings.
The test is not readily available to the general public. There are no specific guidelines about who should undergo DEXA scanning for body fat analysis. However, researchers suggest that the scans may help with treatment for the following groups:. This helps with assessing body fat composition.
In order to determine body density, a person must divide body weight, or mass, by body volume. The volume of an object is how much space it takes up. Hydrodensitometry involves submerging a person in water and measuring the volume of water that they displace.
This displacement indicates body volume. Following hydrodensitometry, a person can use body mass and volume measurements to calculate body density with an equation. A further equation converts body density into body fat percentage.
During ADP, a person sits inside an enclosed device called a Bod Pod. Scales inside the Bod Pod measure body mass, while air pressure sensors measure the amount of air displaced by the person. The volume of air displaced indicates body volume. A 3D body scanner uses lasers to create a 3D image of the body.
The scanner rotates to take pictures of the body from different angles, and the scan is quick, taking only a few seconds. A computer then combines the individual pictures to form the 3D image. With this image, it is possible to determine body volume.
Dividing body mass by body volume can indicate body density. Below are body fat ranges for males and females, according to the American College of Sports Medicine :.
There are various ways to accurately measure body fat percentage. Some methods are simple and inexpensive, while others are more complicated and costly. Some of these methods, including DEXA scans, hydrodensitometry, and ADP, are only available at specialized facilities. However, a person can estimate their body fat composition at home by other means.
A doctor or personal trainer can offer additional advice on taking accurate body measurements. Body fat scales are devices that estimate the relative percentages of fat and muscle inside the body.
Read on to learn about how they work and their…. BMI is one measure of body size. Learn about how to calculate BMI for men, the recommended BMI range, and the limitations of BMI as an indicator of….
Body fat scales can be an easy way to track body composition, but research debates their accuracy. Here, learn about body fat scales and the best…. Sustainable weight management involves eating a balanced diet, exercising regularly, and engaging in stress-reducing techniques.
Learn more. Pannus stomach occurs when excess skin and fat hang down from the abdomen. Pregnancy and weight loss can cause pannus stomach.
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Medical News Today. Health Conditions Health Products Discover Tools Connect. What ways are there to measure body fat? Medically reviewed by Daniel Bubnis, M. Skinfolds Circumference Scales DEXA Hydrodensitometry Air displacement plethysmography 3D body scanners Healthy ranges Summary There are various ways to measure body fat.
Skinfold measurements. Share on Pinterest A person can estimate their body fat percentage by measuring the thickness of skinfolds in different areas of the body. Circumference measurements. Body fat scales. Share on Pinterest There are a number of bathroom scales available that can estimate body fat percentage.
Dual-energy X-ray absorptiometry DEXA. Air displacement plethysmography. Healthy ranges. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.
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How to calculate BMI in men and what the results mean.
: Body volume assessment technique| Latest news | demonstrated that using non-specific impedance measurement equations can lead to an erroneous interpretation of FFM values in male subjects with spinal cord injury, indicating the need to develop new predictive equations for this group. Mattiello et al. de Moraes et al. The authors concluded that research with adolescents considering phase angle should use multilevel modeling with standardized parameters as default to adjust for the concurrent influence of sex, age, maturity status, and body size. Using anthropometric measurements, such as body mass, height, body circumferences, and indices based on these and other measures derived from bioelectrical impedance analysis constitutes a tool for risk screening for adverse health conditions throughout life 13 , These measurements or indices may be associated with arterial properties and variations Gómez-García et al. In this Research Topic, five articles performed interventions to analyze different outcomes. Sheikholeslami-Vatani and Rostamzadeh investigated the effect of 8 weeks of high-intensity interval training and vitamin D3 supplementation on changes in appetite-dependent hormones and body composition in sedentary overweight men, finding satisfactory results. In the study by Lazzer et al. They carried out a randomized controlled trial to test the effects of aquatic resistance training and dietary education on health indicators in older women, including body composition. The results suggest that older women who practice regular and programmed underwater resistance training, among other benefits, have improved body composition variables smaller fat compartments and greater muscle mass. Another randomized controlled trial aimed to verify the impacts of water supplementation on body composition indices in young adults after a h overnight fast to determine the ideal volume of water to improve body water composition. Among other findings, the authors concluded that mL was the minimum volume capable of improving the distribution of water content among the participants of this study Zhang et al. And finally, studying preterm-born preschoolers with very low birth weight, Fernandes et al. verified the impact of a continuous early home-based intervention program on body composition. The study showed that an early intervention protocol from the newborn intensive care unit NICU to a home program performed by mothers of preterm with very low birth weight VLBW children from low-income families has a small effect on fat-free mass. As mentioned, this Research Topic also published a systematic review and meta-analysis that surveyed diagnostic studies to identify the optimal cutoff value for the waist-to-height ratio WHtR to predict central obesity in children and adolescents. The 12 articles included in the meta-analysis led to the conclusion that 0. In summary, the results of the studies and the review in this volume bring a substantial amount of relevant data on body composition assessment techniques in their different uses. Thus, these manuscripts contribute to a better understanding and better using different techniques for estimating body components in clinical and field situations to optimize dietary and physical exercise programs. All authors participated in the elaboration, writing, revision and approval of the final document of this editorial. We thank all the authors who submitted their manuscripts to this Research Topic, contributing substantially to the production of knowledge in the field of Body Composition Assessment. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Campa F, Toselli S, Mazzilli M, Gobbo LA, Coratella G. Assessment of body composition in athletes: a narrative review of available methods with special reference to quantitative and qualitative bioimpedance analysis. doi: PubMed Abstract CrossRef Full Text Google Scholar. Kuriyan R. 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Pediatr Nephrol ; — Steuer RR, Germain MJ, Leypoldt JK, Cheung AK: Enhanced fluid removal guided by blood volume monitoring during chronic hemodialysis. Merouani A, Kechaou W, Litalien C, Ducruet T, Jouvet P: Impact of blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury. Goldstein SL, Smith CM, Currier H: Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis. Gabrielli D, Krystal B, Katzarski K, Youssef M, Hachache T, Lopot F, et al: Improved intradialytic stability during haemodialysis with blood volume-controlled ultrafiltration. J Nephrol ; — Nesrallah GE, Suri RS, Guyatt G, Mustafa RA, Walter SD, Lindsay RM, et al: Biofeedback dialysis for hypotension and hypervolemia: a systematic review and meta-analysis. Jain SR, Smith L, Brewer ED, Goldstein SL: Non-invasive intravascular monitoring in the pediatric hemodialysis population. Pediatr Nephrol ; 15— Shoji T, Tsubakihara Y, Fujii M, Imai E: Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Burton JO, Jefferies HJ, Selby NM, McIntyre CW: Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol ; 4: — de los Reyes VA, Fuertinger DH, Kappel F, Meyring-Wosten A, Thijssen S, Kotanko P: A physiologically based model of vascular refilling during ultrafiltration in hemodialysis. J Theor Biol ; — Kron S, Schneditz D, Leimbach T, Aign S, Kron J: Vascular refilling is independent of volume overload in hemodialysis with moderate ultrafiltration requirements. Hemodial Int ; — Reddan DN, Szczech LA, Hasselblad V, Lowrie EG, Lindsay RM, Himmelfarb J, et al: Intradialytic blood volume monitoring in ambulatory hemodialysis patients: a randomized trial. Maduell F, Arias M, Masso E, Fontsere N, Carrera M, Vera M, et al: Sensitivity of blood volume monitoring for fluid status assessment in hemodialysis patients. Krepel HP, Nette RW, Akcahuseyin E, Weimar W, Zietse R: Variability of relative blood volume during haemodialysis. Andrulli S, Colzani S, Mascia F, Lucchi L, Stipo L, Bigi MC, et al: The role of blood volume reduction in the genesis of intradialytic hypotension. Kron J, Schneditz D, Leimbach T, Aign S, Kron S: A simple and feasible method to determine absolute blood volume in hemodialysis patients in clinical practice. Thijssen S, Kappel F, Kotanko P: Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif ; 63— Kron S, Schneditz D, Leimbach T, Czerny J, Aign S, Kron J: Determination of the critical absolute blood volume for intradialytic morbid events. Onofriescu M, Hogas S, Voroneanu L, Apetrii M, Nistor I, Kanbay M, et al: Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial. Earthman C, Traughber D, Dobratz J, Howell W: Bioimpedance spectroscopy for clinical assessment of fluid distribution and body cell mass. Nutr Clin Pract ; — Jaffrin MY, Morel H: Body fluid volumes measurements by impedance: a review of bioimpedance spectroscopy BIS and bioimpedance analysis BIA methods. Med Eng Phys ; — Ward LC: Segmental bioelectrical impedance analysis: an update. Curr Opin Clin Nutr Metab Care ; — Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI: Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr ; — Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A, et al: Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas ; — De Lorenzo A, Andreoli A, Matthie J, Withers P: Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. Zhou YL, Liu J, Sun F, Ma LJ, Han B, Shen Y, et al: Calf bioimpedance ratio improves dry weight assessment and blood pressure control in hemodialysis patients. Am J Nephrol ; — Seibert E, Müller SG, Fries P, Pattmöller J, Kuss O, Heine GH, et al: Calf bioimpedance spectroscopy for determination of dry weight in hemodialysis patients: effects on hypertension and left ventricular hypertrophy. Kidney Blood Press Res ; 58— Zhu F, Kuhlmann MK, Kotanko P, Seibert E, Leonard EF, Levin NW: A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique. Physiol Meas ; S—S Barbosa-Silva MC, Barros AJ: Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations. Curr Opin Clin Nutr Metab Care ; 8: — Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gomez J, et al: Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr ; — Tsai YC, Chiu YW, Tsai JC, Kuo HT, Hung CC, Hwang SJ, et al: Association of fluid overload with cardiovascular morbidity and all-cause mortality in stages 4 and 5 CKD. Clin J Am Soc Nephrol ; 39— Oei EL, Fan SL: Practical aspects of volume control in chronic kidney disease using whole body bioimpedance. Blood Purif ; 32— Chamney PW, Kramer M, Rode C, Kleinekofort W, Wizemann V: A new technique for establishing dry weight in hemodialysis patients via whole body bioimpedance. Chazot C, Wabel P, Chamney P, Moissl U, Wieskotten S, Wizemann V: Importance of normohydration for the long-term survival of haemodialysis patients. Wabel P, Chamney P, Moissl U, Jirka T: Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif ; 75— Dekker MJ, Marcelli D, Canaud BJ, Carioni P, Wang Y, Grassmann A, et al: Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Raimann JG, Zhu F, Wang J, Thijssen S, Kuhlmann MK, Kotanko P, et al: Comparison of fluid volume estimates in chronic hemodialysis patients by bioimpedance, direct isotopic, and dilution methods. Marcelli D, Usvyat LA, Kotanko P, Bayh I, Canaud B, Etter M, et al: Body composition and survival in dialysis patients: results from an international cohort study. Clin J Am Soc Nephrol ; — Arroyo D, Panizo N, Abad S, Vega A, Rincon A, de Jose AP, et al: Intraperitoneal fluid overestimates hydration status assessment by bioimpedance spectroscopy. Perit Dial Int ; 85— Davies SJ, Davenport A: The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Tangvoraphonkchai K, Davenport A: Do bioimpedance measurements of over-hydration accurately reflect post-haemodialysis weight changes? Nephron ; — Siriopol I, Siriopol D, Voroneanu L, Covic A: Predictive abilities of baseline measurements of fluid overload, assessed by bioimpedance spectroscopy and serum N-terminal pro-B-type natriuretic peptide, for mortality in hemodialysis patients. Arch Med Sci ; — Voroneanu L, Cusai C, Hogas S, Ardeleanu S, Onofriescu M, Nistor I, et al: The relationship between chronic volume overload and elevated blood pressure in hemodialysis patients: use of bioimpedance provides a different perspective from echocardiography and biomarker methodologies. Ozdogan O, Kayikcioglu M, Asci G, Ozkahya M, Toz H, Sezis M, et al: Left atrial volume predicts mortality in low-risk dialysis population on long-term low-salt diet. Am Heart J ; — Mostafa G, Kumar M, Schlotthauer J, Murray MJ: The utility of hemodynamic measurements acquired by pulmonary artery catheterization. Am J Surg ; — Marik PE, Cavallazzi R: Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Marik PE, Baram M, Vahid B: Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al: Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Elwan MH, Hue J, Green SJ, Eltahan SM, Sims MR, Coats TJ: Thoracic electrical bioimpedance versus suprasternal Doppler in emergency care. Emerg Med Australas ; — Light LH: Non-injurious ultrasonic technique for observing flow in the human aorta. Nature ; — Chong SW, Peyton PJ: A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor USCOM. Anaesthesia ; — Oda M, Hokama S, Sugaya K, Hatano T, Ogawa Y: New blood volume monitoring method for hemodialysis: A-V pressure gradient measurement by synchronized one-point reading. Kim W, Park SK, Kang KP, Lee DH, Kim SY, Jung JM, et al: Changes in whole blood viscosity at low shear rates correlate with intravascular volume changes during hemodialysis. Yin Z, Zhou J, Cai S, Wang Z: On-line dynamic measurement of blood viscosity, hematocrit and change of blood volume. Chin J Traumatol ; 3: — Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM, et al: Bioelectrical impedance analysis — part I: review of principles and methods. Zhu F, Levin NW: Estimation of body composition and normal fluid status using a calf bioimpedance technique. Blood Purif ; 25— Ribitsch W, Stockinger J, Schneditz D: Bioimpedance-based volume at clinical target weight is contracted in hemodialysis patients with a high body mass index. Karger AG, Basel. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor s. The publisher and the editor s disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. View Metrics. Email alerts Online First Alert. Latest Issue Alert. Citing articles via Web Of Science CrossRef Japanese study of the effects of AMG α1-microglobulin reduction rates on survival JAMREDS : protocol of a multicenter prospective observational cohort study. Global scientific trends in continuous renal replacement therapy from to A bibliometric and visual analysis. Suggested Reading Point-of-Care Ultrasound versus Chest X-Ray for Determining Lung Expansion Based on Rib Count in High-Frequency Oscillatory Ventilation Neonatology August, Changes in Total Protein Concentration Due to Fluid Removal During and Shortly after Hemodialysis Am J Nephrol August, The Role of Peripheral Ultrafiltration in the Management of Acute Decompensated Heart Failure Blood Purif January, Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients Kidney Blood Press Res December, Online ISSN Print ISSN |
| How to measure body fat: Accurate methods and ranges | Burton JO, Jefferies HJ, Selby NM, McIntyre CW: Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clearly structured and written, the present book is a practical tool for physicians and professionals involved in the management and care of patients with combined heart and kidney disorders. Article PubMed Google Scholar Panebianco NL, Shofer F, Cheng A, Fischer J, Cody K, Dean AJ. However, too much body fat can lead to obesity and other chronic diseases, such as type 2 diabetes and heart disease. Pregnancy and weight loss can cause pannus stomach. |
| How to Measure | A systematic review asseswment the assessmsnt and the tale of seven mares. Crit Care Body volume assessment technique ; — This helps with assessing body fat composition. Eur J Radiol. J Clin Anesth ; — Arch Intern Med ; — Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. |
| Measuring Obesity | It is important for people to take the measurements at the same sites each time. People can then enter these measurements into an online calculator , which estimates body fat percentage. It is important to note that skinfold measurements vary widely, and body fat distribution can differ, based on race, age, sex, and physical activity. A person can easily estimate their body fat percentage by measuring the circumference of different parts of their body. They should use a tape measure to do this. To get a more accurate estimation, measure the circumference of the neck and waist. Females should also measure the circumference of the hips. Take measurements at the widest point, and ensure that the tape measure does not compress the skin. Some bathroom scales estimate body fat percentage. They use a method called bioelectrical impedance analysis BIA. BIA involves passing a very weak electrical current through the body to measure its resistance to the current. Body fat is particularly resistant, meaning that it conducts electricity less effectively than other tissues and substances within the body. Therefore, measurements that show a greater resistance indicate a higher body fat mass. Scales can use this measurement and information about gender, age, and height to estimate body fat percentage. According to a study , BIA can give a reasonable estimate of body fat percentage. However, it is not the most accurate method available. A DEXA scan uses X-rays to precisely measure body fat, lean muscle, and mineral composition in different parts of the body. The scan is similar to any X-ray and only takes a few minutes. The amount of radiation that the scan emits is low. Typically, researchers use DEXA scans to measure body fat percentage in research settings. The test is not readily available to the general public. There are no specific guidelines about who should undergo DEXA scanning for body fat analysis. However, researchers suggest that the scans may help with treatment for the following groups:. This helps with assessing body fat composition. In order to determine body density, a person must divide body weight, or mass, by body volume. The volume of an object is how much space it takes up. Hydrodensitometry involves submerging a person in water and measuring the volume of water that they displace. This displacement indicates body volume. Following hydrodensitometry, a person can use body mass and volume measurements to calculate body density with an equation. A further equation converts body density into body fat percentage. During ADP, a person sits inside an enclosed device called a Bod Pod. Scales inside the Bod Pod measure body mass, while air pressure sensors measure the amount of air displaced by the person. The volume of air displaced indicates body volume. A 3D body scanner uses lasers to create a 3D image of the body. The scanner rotates to take pictures of the body from different angles, and the scan is quick, taking only a few seconds. A computer then combines the individual pictures to form the 3D image. With this image, it is possible to determine body volume. Dividing body mass by body volume can indicate body density. Below are body fat ranges for males and females, according to the American College of Sports Medicine :. There are various ways to accurately measure body fat percentage. Some methods are simple and inexpensive, while others are more complicated and costly. Some of these methods, including DEXA scans, hydrodensitometry, and ADP, are only available at specialized facilities. However, a person can estimate their body fat composition at home by other means. A doctor or personal trainer can offer additional advice on taking accurate body measurements. Body fat scales are devices that estimate the relative percentages of fat and muscle inside the body. Read on to learn about how they work and their…. BMI is one measure of body size. Learn about how to calculate BMI for men, the recommended BMI range, and the limitations of BMI as an indicator of…. Body fat scales can be an easy way to track body composition, but research debates their accuracy. Here, learn about body fat scales and the best…. Sustainable weight management involves eating a balanced diet, exercising regularly, and engaging in stress-reducing techniques. During spontaneous respiration, the IVC collapses when intra-thoracic pressure decreases during inspiration and distends when intra-thoracic pressure increases during expiration. However, intermittent mechanically positive pressure ventilation reverses this filling relationship as the IVC distends during inspiration and collapses during expiration due to the change in intra-thoracic pressure. This phasic respiratory variation of IVC will decrease with the increase of venous pressure, because the effect of changing intra-thoracic pressure is getting smaller. Ultrasound examination of the IVC is highly practical and reproducible. It is usually done via the subcostal area just below the xiphoid bone, or at the right anterior axillary line using the liver as an acoustic window. A low frequency phased array transducer should be used for scanning. The IVC is differentiated from the abdominal aorta by its thin wall, collapsibility, and lack of pulsatile blood flow. However, the anatomical location where one measures the IVC seems important. Wallace et al. found that IVC collapsibility index CI was affected by the location of the scan in spontaneously breathing adults, either at the junction with atrium or distal to hepatic veins [ 9 ]. The American Society of Echocardiography recommends evaluating the IVC just proximal to the hepatic vein, approximately 0. The IVC can be evaluated both in short-axis or long axis views. The maximum and minimum IVC diameters should be measured perpendicular to the long axis of IVC and at end-expiration and end-inspiration during one respiratory cycle. M-mode Doppler can also be used for IVC measurements, but this method may introduce error because of the IVC movement relative to the transducer due to diaphragm movement during respiration. Therefore, it is recommended to use M-mode for evaluation after ensuring IVC visualization in B-mode [ 11 ]. The CI and DI represent the collapsibility of IVC under different ventilation modes. A short period of training with 20 clinical cases has been shown to significantly improve the diagnosis of vascular overload when performed using hand-carried ultrasound by internal medicine residents [ 12 ]. After a dedicated curriculum of lectures and reading materials and a 3-hour practical training session using echocardiography, trainees showed moderate agreement with board certified cardiologists in IVC diameter and collapsibility assessment [ 13 ]. A study reported high inter-rater reliability for measurements of IVC diameter and lower but still moderate to good inter-rater reliability for estimation of IVC percentage collapse between emergency physicians [ 14 ]. Another study reported moderate inter-rater reliability for IVC diameter measurements between emergency residents [ 15 ]. Patient position was also reported to have little influence on IVC ultrasound metrics [ 8 ]. Ultrasound measurements of IVC diameter and its variation during respiration were recommended for estimating volume status [ 11 , 16 ]. Both the absolute IVC diameter and its respiratory variation have been used to assess volume status [ 7 ]. These parameters were proposed as repeatable and easy to obtain by operators with limited echocardiography experience [ 17 ]. Ultrasound measurement of the IVC has been studied extensively as a predictor of fluid responsiveness in a variety of patients under different circumstances [ 18 , 19 ], and several studies have demonstrated that IVC diameter and its variation are reliable indicators of intravascular volume status [ 20 , 21 , 22 , 23 ]. A study reported that inadequate increase in IVC diameter after fluid challenge was more sensitive than blood pressure for identifying hypovolemic trauma patients [ 24 ]. It has been demonstrated that IVC diameter is consistently low in hypovolemic patients and there was a significant increase in IVC size after fluid resuscitation [ 23 ]. A meta-analysis including five observational studies found that maximum IVC diameter was significantly lower in hypovolemic compared with normovolemic patients [ 18 ]. Qualitative assessment of IVC size and its collapsibility have been successfully used for evaluating fluid status in critically ill patients [ 25 ]. The DI has also been validated for predicting fluid responsiveness in mechanically ventilated patients [ 20 , 29 ]. A recent meta-analysis of eight studies and patients demonstrated a pooled sensitivity of 0. Higher IVC collapsibility suggests a low volume state, especially together with a small maximum IVC diameter; conversely, lower IVC collapsibility with a large maximum IVC diameter indicates a high volume state. Using IVC respiratory variation for volume assessment needs to measure IVC diameter during respiratory cycle. This parameter was proved to be consistent when measured from different plane and easy to perform in young adults [ 31 ]. IVC ultrasonography has been used to identify patients with congestive heart failure and volume overload [ 33 ], and for helping physicians in the diagnosis of patients with undifferentiated hypotension [ 34 ]. It has been demonstrated that increased IVC diameter in chronic heart failure patients was related to adverse outcome [ 35 ]. A recent study by Zhang et al. found that ultrasound IVC measurements, CI, and maximum diameter, prior to induction of general anesthesia were predictive of subsequent hypotension [ 36 ]. This preliminary study showed that preoperative ultrasound measurements can provide prognostic information for hypotension after induction of general anesthesia. Another study also found that IVC CI was predictive of significant hypotension developed from propofol after induction [ 37 ]. It is suggested that a rapid ultrasound examination of IVC should be done shortly before general anesthesia to screen for those patients who are at risk of developing hypotension, especially the elderly and those suspected of being hypovolemic. The ultrasound examination of IVC is not always successful. This limits its application in obese patients and patients with gastrointestinal obstruction. The absolute IVC size varies widely among individuals, and current evidence did not provide a definitive reference value for IVC measurements when assessing volume status. It is suggested that body size, measured as body surface area, is important to consider when using IVC diameter to assess volume status [ 39 ]. The variation in IVC diameter depends on the intra-thoracic and the intra-abdominal pressure, the CVP, and the compliance of the vessel [ 41 ]. Hence, pathophysiological changes can affect the measurement of IVC, including increase in intra-abdominal pressure and increase in end-inspiratory intra-thoracic pressure due to respiratory diseases, such as asthma and chronic obstructive pulmonary disease. During mechanical ventilation, pre-set ventilator parameters, such as tidal volume, positive end-expiratory pressure, have different influences on intra-thoracic pressure and thus change the IVC measurements. The status of patient can affect the respiratory variation of IVC when spontaneously breathing. For example, a young and fit patient will generate much greater change in intra-thoracic pressure during inspiration, compared with an elder and frail patient. The IVC variation also has to be interpreted with caution in patients with known right heart failure, pulmonary hypertension, severe tricuspid regurgitation as right atrial overload tends to cause IVC distention. All these situations should be taken into consideration when interpreting the IVC measurements. Although the IVC ultrasonography is recommended for volume assessment, it is still difficult to apply its use in the perioperative period for consistent monitoring. There is an inability to monitor IVC change before and after tracheal intubation under general anesthesia, because positive pressure ventilation that is initiated after tracheal intubation will change IVC diameter and the IVC respiratory variation is reversed by switching from spontaneous respiration to mechanical ventilation. Furthermore, general anesthetics could also affect the IVC. Bedside IVC ultrasonography is rapid, easy to acquire, and provides reliable indicators for volume assessment. With greater availability of high definition point-of-care ultrasound equipment, it is becoming increasingly practicable to incorporate quick ultrasound scanning into daily practice to facilitate clinical decision, especially in the perioperative, intensive care and emergency settings. However, one should be aware of that IVC ultrasonography is burdened with limitations. Hence, the measurements should be done using standard procedure, and the results should be interpreted with adequate knowledge of physiology. The clinical context and pathophysiological state are important when using ultrasound IVC measurements to assess volume status. Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. Article PubMed Google Scholar. Junghans T, Neuss H, Strohauer M, Raue W, Haase O, Schink T, et al. Hypovolemia after traditional preoperative care in patients undergoing colonic surgery is underrepresented in conventional hemodynamic monitoring. Int J Color Dis. Article Google Scholar. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Wiesenack C, Prasser C, Keyl C, Rödīg G. Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. J Cardiothorac Vasc Anesth. Article CAS PubMed Google Scholar. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Fluid responsiveness: an evolution of our understanding. Br J Anaesth. Definiton of fluid responsiveness and its use for volume assessment. Kalantari K, Chang JN, Ronco C, Rosner MH. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int. Panebianco NL, Shofer F, Cheng A, Fischer J, Cody K, Dean AJ. The effect of supine versus upright patient positioning on inferior vena cava metrics. Am J Emerg Med. Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers. Acad Emerg Med Off J Soc Acad Emerg Med. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. This article is guidelines from the American Society of Echocardiography and describes the standard procedure for performing ultrasound scan when measuring the IVC. Seif D, Mailhot T, Perera P, Mandavia D. Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol. Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J. Fields JM, Lee PA, Jenq KY, Mark DG, Panebianco NL, Dean AJ. The interrater reliability of inferior vena cava ultrasound by bedside clinician sonographers in emergency department patients. Acad Emerg Med. Akkaya A, Yesilaras M, Aksay E, Sever M, Atilla OD. The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents. Nakamura K, Tomida M, Ando T, Sen K, Inokuchi R, Kobayashi E, et al. Cardiac variation of inferior vena cava: new concept in the evaluation of intravascular blood volume. Journal of Medical Ultrasonics. Brennan JM, Ronan A, Goonewardena S, Blair JE, Hammes M, Shah D, et al. Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clinical journal of the American Society of Nephrology : CJASN. Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Zhang Z, Xu X, Ye S, Xu L. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol. Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. PubMed Google Scholar. Gunst M, Ghaemmaghami V, Sperry J, Robinson M, O'Keeffe T, Friese R, et al. Journal of Trauma-Injury Infection and Critical Care. Schefold JC, Storm C, Bercker S, Pschowski R, Oppert M, Kruger A, et al. Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanically ventilated intensive care unit patients with sepsis. The Journal of emergency medicine. Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. Yanagawa Y, Sakamoto T, Okada Y. Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma. Ferrada P, Anand RJ, Whelan J, Aboutanos MA, Duane T, Malhotra A, et al. Qualitative assessment of the inferior vena cava: useful tool for the evaluation of fluid status in critically ill patients. Am Surg. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. |
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