BIA body fluid compartment analysis -
Because not all BIA users have machines delivering a kHz current, we investigated equations derived for 50 kHz and kHz frequencies. For our group of patients, estimated TBW differed from reference measurements by 0.
Although these differences are statistically significant probably as the result of the large number of degrees of freedom we believe that they are acceptable in clinical practice.
We also consider that height calculated from knee height 15 can be used because the difference it induces in comparison to measured height is minimal 0.
Therefore, BIA can be used as a discriminative tool for TBW measurement. It is also important that this applies to situations with varying degrees of hydration, precisely when clinicians require an estimate of TBW. The present study involved subjects with a mild degree of dehydration.
This is because written informed consent was required for participating in the study. Although dehydrated patients are numerous, dehydration impairs cognitive functions and prevents an informed consent. The high prevalence of fluid imbalance makes BIA an attractive tool.
Even for those patients in whom the estimated TBW was different from the measured TBW, it could be hypothesized that BIA is a good tool for monitoring changes in fluid balance.
Support for this comes from a study by Olde Rikkert and colleagues This means that repeated measurements were within 1 l for those subjects. Furthermore, Olde Rikkert and colleagues 14 showed that the weight and water loss induced by a furosemide administration were correctly monitored by BIA.
Individual differences shown in Fig. However, the reproducibility of BIA estimates in the short term 8 and over longer periods [28 days 11 ] suggests that a subject with a large residual in Fig.
BIA could therefore be useful in monitoring changes in TBW. In contrast, BIA with published equations leads to systematic biases in estimating ECW when applied to the geriatric patients of the present study. Visser and colleagues' equations 9 , derived from healthy elderly subjects, has proven accurate in our group of healthy subjects mean difference 0.
The same was true for Segal and colleagues' equation 18 , although it was derived from adults mean difference 0. The bias observed in the present geriatric patients could come from an inaccurate measurement of ECW with Br, from altered electrical properties of cell membranes, or from changes in fluid repartition.
It is unlikely that the Br measurements are erroneous. Indeed, the same technique was used for healthy subjects 8 , and in the present study, the mean CV for plateau concentration in Br was 1.
Furthermore, Finn and colleagues 6 , in a study of critically ill patients, and Kim and colleagues 24 , in a study of AIDS patients, have shown that intracellular penetrance of the Br tracer is not changed appreciably.
Steen 25 showed that the ratio of ECW to TBW increased with age. If the extracellular fluid expansion was mostly in the limbs, impedance at 5 kHz would be underestimated and ECW artificially increased. Furthermore, limbs represent the largest component of the impedance of the body.
ECW was not correlated to plasma sodium, osmolality, or classical protein markers of malnutrition data not shown. We have derived an equation to calculate ECW in geriatric patients. This equation remains to be evaluated in other diseased patients.
In conclusion, BIA with specific equations for elderly subjects could be used as a bed-site tool for discriminative diagnosis and for monitoring changes in fluid balance in geriatric patients.
This validity applies to TBW across the range of hydration disorders. Data are limited to 84 values 47 women and 37 men and were obtained by bromide dilution.
See Methods for the description of the hydration categories. Regression Models Established to Predict Extracellular Water From Impedance Measured at 5 kHz. The y -axis is the difference between the two measurements, and the x -axis is the mean of measured and estimated values.
The Source Study is a French multicentric study coordinated by Dr. Ritz Human Nutrition Research Centre-Auvergne. Investigators were by alphabetical order : Dr. Acher Paris, Bichat , Pr.
Beaufrère Clermont-Ferrand , F. Blondé-Cynober Paris, Hôtel-Dieu , Dr. Boulier Paris, Bichat , Dr. Bouthier, Dr. Bouthier-Quintard Limoges , Pr. Constans, Dr. Dardaine Tours , Dr. Desport Limoges , Dr. Ghisolfi-Marque Toulouse , Dr. Hermet Clermont-Ferrand , Dr. Lambert Paris, E. Roux , Pr.
Vellas Toulouse , Dr. Vincent Paris, E Roux , and Dr. Arnaud Perrier Vittel Water Institute. We thank Line Godiveau for secretarial assistance and Miriam Ryan for correcting the English. Weinberg AD, Minaker KL, and the council of scientific affairs, American Medical Association Dehydration: evaluation and management in older adults.
Molaschi M, Ponzetto M, Massaia M, Scarafiotti C, Ferrario E, Hypernatremic dehydration in the elderly on admission to hospital. Age Nutrition. Leaf A, Dehydration in the elderly. N Engl J Med. Mooradian AD, Water balance in the elderly.
Morley JE, Korenman SG, , ed. Endocrinology and Metabolism in the Elderly Blackwell Scientific Publications, Boston, MA.
Shizgal HM, Soloman S, Gutelius JR, Body water distribution after operation. Surg Gynecol Obstet : 35 Finn PJ, Plank LD, Clark MA, Connolly AB, Hill GL, Progressive cellular dehydration and proteolysis in critically ill patients. Clasey JL, Kanaley JA, Wideman L, et al.
Validity of methods of body composition assessment in young and older men and women. J Appl Physiol. Vaché C, Rousset P, Gachon P, et al.
Bioelectrical impedance analysis measurements of total body water and extracellular water in healthy elderly subjects. Int J Obes. Visser M, Deurenberg P, Van Staveren WA, Multi-frequency bioelectrical impedance for assessing total body water and extracellular water in elderly subjects.
Eur J Clin Nutr. Bussolotto M, Ceccon A, Sergi G, Giantin V, Beninca P, Enzi G, Assessment of body composition in elderly: accuracy of bioelectrical impedance analysis. Olde Rikkert MGM, Deurenberg P, Jansen RWMM, van't Hof MA, Hoefnagels WHL, Validation of multifrequency bioelectrical impedance analysis in monitoring fluid balance in healthy elderly subjects.
J Gerontol Med Sci. Deurenberg P, Schouten FJM, Loss of total body water and extracellular water assessed by multifrequency impedance.
De Lorenzo A, Barra PFA, Sasso GF, Battistini NC, Deurenberg P, Body impedance measurement during dialysis. Validation of multifrequency bioelectrical impedance analysis in detecting changes in fluid balance of geriatric patients.
J Am Geriatr Soc. Chumlea WC, Roche AF, Steinbaught ML, Estimating stature from knee height for persons 60 to 90 years of age. Miller ME, Cappon CJ, The body fluids are traditionally divided into an extracellular volume ECV and an intracellular volume ICV.
These fractions have been challenged by studies, where electric bioimpedance analysis BIA has been applied. It is unclear whether the textbook volumes or the BIA-derived volumes are correct.
In the present work, we study the usefulness of mass balance equations to examine whether a reported body fluid size is reasonable or more likely to be erroneous. For this purpose, we applied a sodium and an osmolality equation that are dependent on correct sizes of the ECV and ICV to estimate the transcellular shift of water after a fluid challenge [ 13 , 14 ].
The composition and amount of fluid administered determine direction and volume of fluid exchange, which are fairly well known for the literature. However, the relevance of using fluid shift calculations as a quality control of reported body volumes has never been studied.
We used data obtained during experiments in volunteers, where BIA had been measured and isotonic and hypertonic electrolyte fluids were infused in volunteers [ 14 , 15 ]. The report is a retrospective analysis of two prospective studies of hemodilution during fluid therapy in volunteers.
Informed consent was obtained from all participants. Data was treated according to confidentiality guidance. The studies originally comprised 80 infusions of both isotonic and hypertonic fluids, but we only used the subset of 15 experiments collected when the 8 volunteers were euvolemic and all data necessary for the evaluation was present.
The volunteers had a light breakfast consisting of one glass of water or milk and one sandwich at least 2 h before the infusion. They voided and were weighed just before the infusion started.
A recumbent equilibration period of 30 min was allowed before the experiments were initiated. All infusions were administered at a constant rate over 30 min using infusion pump. Volunteers received both types of infusion.
The washout period between the experiments was at least 1 week. Blood samples were drawn just before the infusions started, at the end of the infusions at 30 min , and at min. The urinary excretion was measured at min and taken into consideration for sodium and osmolality equation calculation at that point in time.
Hence, any adjustment of the fluid shifts indicated by the osmolality equation at 30 min and min was solely due to urinary losses of water and osmolality. By contrast, the sodium equation considered measurements of serum sodium both at 30 min and min in addition to urinary losses at min.
Osmolality was measured by an Osmometer 3C2 Advanced Instruments Inc. The size of the ECV and the ICV were estimated by multi-frequency bioelectrical impedance Xitron B Bioimpedance Spectrum Analyzer, Xitron Technologies Inc. The software calculates these volumes based on a series of 50 currents of different frequencies between electrodes affixed to the dorsum of one hand and one foot.
The mean of three consecutive measurements was used. The diffusion of fluid into and out of the cells fluid shift was calculated by both a sodium equation and an osmolality equation.
The sodium equation is based on a mass balance concept implying that sodium ions Na and water in the ECV remain constant over time except for additions and losses. All these additions and losses are known except for fluid exchange between the ECV and ICV spaces.
Since Na is distributed throughout the ECV space, the serum Na concentration at any time T during or after an intravenous infusion of fluid Na T equals the amount of Na in the ECV volume divided by the current ECF volume.
The serum concentration before the intervention, Na o , and at any time t after it has occurred, Na T are then connected in the following equation [ 13 ]:. If urinary excretion has occurred, the voided volume should be subtracted from the infused fluid volume.
Similarly, the sodium ions excreted in the urine should be subtracted from the infused amount of sodium. The positive and negative signs in the sodium equation were inverted to enable comparison between equations.
The osmolality equation is built on the fact that the osmolality is always the same in the ECV and ICV. Hence, we can derive [ 14 ]:.
This mass balance equation implies that the amount of solutes divided by the fluid volume must remain the same after manipulation of any of involved factors. Note that no second blood sample is needed. A positive sign in fluid shift of both equations indicates transfer from ICV to ECV.
Data is presented as the mean and standard deviation SD. Data analysis was carried out using the R statistical programming environment version 3. A complete data set was obtained from 15 experiments that were performed in eight male volunteers with a mean age SD of 32 8 years and with a BW of 82 9 kg.
The ECV measured with BIA was Table 1 depicts the measured and theoretically assumed ECV and ICV for each experiment and fluid group. Table 2 shows the infused and excreted amounts of fluid and electrolytes for each experiment and fluid group.
The mean SD initial serum osmolality was The mean volume SD infused in the Ringer group was 1. The urinary losses of solutes and water were considered in the calculation at min but these data were not available at 30 min. Each point is one measurement two in each volunteer.
No correction for urinary excretion was performed. Figure 2 illustrates the displacement of the data that occurs when the excreted fluid, sodium, and osmolality has been incorporated into the equations at min no measurement of losses are available at 30 min.
Same plot as Fig. Such data were not available at 30 min. The left displacement of the curve at min as compared to Fig. These simulations showed that the ECV but not the ICV greatly affected the calculated fluid shift Fig. Transfer of fluid from the ICV to the ECV as estimated by the A Sodium equation and B Osmolality equation.
The same fluid shift would be obtained by the sodium equation if the ECV had been With that ECV size, the fluid recruitment of hypertonic fluid became virtually identical at mL.
On setting the ECV to 1. Therefore, according to our simulation, the BIA did not provide a truthful estimate of the ECV. The slope obtained by assuming different values of ICV was not steep enough for reaching a reasonably firm conclusion about the size of the ICV.
Instead, we plotted the osmolar balance at min versus the change in serum osmolality for the hypertonic infusions to obtain a figure of the size of the ICV.
This regression showed that adding mosmol to the body corresponded to a rise in serum osmolality of One extreme outlier is not shown. Our results illustrate that solute equations can be applied after an infusion of isotonic or hypertonic fluid to ascertain whether assumed or measured ECV is reasonable from a physiological point of view.
The law of osmolality also tells us that hypertonic saline translocates water from the ICV to the ECV assuming textbook fluid compartments. Nevertheless when the solute equations are used they indicate a flow from ECV to ICV if we apply the BIA-derived ECV, which is an aberrant fluid dynamic.
The precise volumes may be modified by urinary excretion and solutes and fluid, but our calculations show that dramatically different flows are predicted if the ECV is changed.
By contrast, the solute equations proved less useful to ascertain whether a reported ICV is reasonable. The transcellular transport of fluid as indicated by of one sodium and one osmolality equation was calculated in a young volunteer population given an infusion of hypertonic or isotonic crystalloid infusion.
The Ringer infusions caused only minor changes of intracellular water, while hypertonic fluid withdrew more than 1 L from the ICV, which represents approximately 4.
One could perhaps expect 7. No data on the urinary excretion was obtained at 30 min, but losses of electrolytes and water were probably quite small at that time. Complete data was only available at min. Then calculations then disclosed a left-sided displacement of the fluid recruitment curve as evidence that some fluid had already returned to the ICV cf.
Our results suggest that calculations based on solute changes can be used to examine how realistic a reported ECV volume is. However, the simulation using the BIA-derived size the ECV is highly unlikely to be correct.
The law of osmolality rather tells us that hypertonic saline recruits fluid from the ICV, and not the opposite. Our results further show that calculations based on solute changes cannot be used to examine how realistic a reported ICV volume is using the same reasoning as for the ECV volume.
The size of the ICV could not be adequately assessed by the osmolality equation. However, a regression plot comparing the osmolar balance and the change in serum osmolality yielded more clear information. There may be several explanations to the difference in body fluid volumes between the textbooks and the more recently obtained BIA values.
Measurement of body fluid volume in vivo. In: Hahn, RG, Prough, DS, Svensén, CH, editors. Perioperative fluid therapy. New York: Informa Healthcare; —11 pp. Bioelectrical impedance analysis in body composition measurement.
National Institutes of Health Technology Assessment Conference Statement, December 12—14, Nutrition ;— Evaluation of multi-frequency bio-impedance analysis for the assessment of extracellular and total body water in surgical patients. Clin Sci ;— Predicting body cell mass with bioimpedance by using theoretical methods.
J Appl Physiol ;— Analytic assessment of the various bioimpedance methods used to estimate body water. Body water compartment measurements: a comparison of bioelectrical impedance analysis with tritium and sodium bromide dilution techniques. Clin Nutr ;— Effects of diet, habitual water intake and increased hydration on body fluid volumes and urinary analysis of renal fluid retention in healthy volunteers.
Eur J Nutr ;— Anesthesiology ;— Kinetics of isotonic and hypertonic plasma volume expanders. Volume kinetics of glucose solutions given by intravenous infusion. Br J Anaesth ;— Volume kinetics of glucose 2. Br J Anaesth ;—8. Do ethanol and deuterium oxide distribute into the same water space in healthy volunteers?
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BIA might also reliably depict changes in body water 11 12 13 Therefore, BIA might be the tool required for the diagnosis and management of fluid imbalance.
Apart from the work by Olde Rikkert and colleagues 14 dealing with body fluid changes, no study has attempted to validate BIA in elderly patients with a wide range of hydration status.
Therefore, the aim of the present study was to check the validity of equations derived by Vaché and colleagues 8 in healthy elderly subjects and in a large group of elderly patients who were overhydrated, euvolemic, or dehydrated.
A total of subjects living in six French institutions were recruited. The study was approved by the Auvergne medical school ethical committee and by the French Ministry of Health.
One ward was a step-down unit, and others were long-stay units. All patients aged 60 years and older admitted to these wards were eligible for the study and were included if they had no exclusion criteria and signed written informed consent. Patients entered the hospital for various reasons e.
All subjects were in clinically stable condition for at least a week after the start of the treatment. No patient was excluded on the basis of drug treatment. Exclusion criteria were: end of life, patients requiring intensive care e.
Physical characteristics of the volunteers are given in Table 1. Table 2 shows water spaces, plasma sodium concentrations, and osmolarity in the three groups. The protocol of the study consisted of the measurement of TBW by 18 O dilution and of the measurement of ECW by Br dilution, plus the determination of BIA and anthropometrical measurements.
Flasks containing the doses were weighed after the doses were given, and the exact weights of the doses taken were recorded. In the validation experiment on healthy elderly subjects 8 , Visser's and Segal's equations were accurate. Therefore, we dosed only 84 patients with Br.
Plasma and urine samples were collected 4 and 5 hours after the dose. In the mean time, the subjects were allowed to have their usual breakfast but were limited to a consumption of ml of water, which is 1 SD for the measurement of TBW with 18 O diluted water 8.
Body weight was measured in light clothing to the nearest 0. Height was measured in subjects who could stand, i. In all volunteers, the knee-to-heel length was measured to the nearest 0. Anthropometric measurements were performed during the 5th hour following the dose of tracers.
BIA measurements were performed with an Analycor-3 analyzer Spengler, Cachan, France. All the investigators had been equipped with analyzers from the same series and had attended a course where the complete procedure was taught.
Measurements were performed after a rest of at least 30 minutes and during the 5th hour post-dose in a temperature-controlled room.
Four surface electrodes Sentry Silver EKG electrodes; Spengler, Cachan, France were placed on clean, degreased skin at the limb ends in a standardized manner. The current injecting electrodes were located in the distal end of the third metacarpal bone and of the second metatarsal bone.
The current detector electrodes were located between the styloid processes of the radius and ulna and between the two maleoli of the ankle. Measurements were performed both on the left and on the right side of the body. Three frequencies were used 5 kHz, 50 kHz, and kHz, at a current of μAmp.
Electronic precision of the instrument is better than 1 Ω, and the response is linear between and Ω. Reproducibility with Sentry electrodes is better than 2 Ω. Plasma Br concentrations were measured by means of high-performance liquid chromatography as described by Miller and Cappon 16 , using a diode array detector Partisil 10 SAX column, Whatman International Ltd.
Protein-free plasma samples were obtained after centrifugation using an MPS1 micropartition system Amicon, Lyon, France. ECW was calculated from the impedance measured at 5 kHz with equations derived by Segal and colleagues 18 and Visser and colleagues 9.
These equations were used because they were accurate in healthy elderly subjects, with the same BIA analyser and the same tracer method.
In all of these equations, Ht is height in cm, R is impedance, wt is weight in kg, and G is gender 0 for women and 1 for men. Results are expressed as mean ± SD unless stated otherwise. Comparisons of means were performed by ANOVA or Student's t test where applicable.
Agreement between measurements was assessed with the technique described by Bland and Altmann Statistical computations were performed on a Statview 4. Physical characteristics for the patients are given in Table 1.
Forty-four patients were dehydrated, 58 were overhydrated, and 67 had a normal hydration status. Impedance did not differ significantly between the right and the left side of the body at current frequencies of 5 kHz, 50 kHz, and kHz data not shown. Therefore, the impedances measured on both sides were averaged for each individual.
TBW calculated with the equation using impedance at 50 kHz differed from TBW measured by 18 O dilution by 0. This difference was not affected by the hydration status or by the gender of the patients. It was 0. TBW calculated with the equation using the impedance at kHz differed from TBW measured by 18 O dilution by 0.
This difference was not affected by the hydration status of the patients 0. For the patients in whom both height and knee height were available, TBW was calculated from the impedance at 50 kHz, and either measured height or height derived from knee height.
TBW estimates only differed by 0. Extracellular water calculated with equations using impedance at 5 kHz differed from ECW measured by Br dilution.
The difference was 4. The subjects having had ECW measured with Br were split into two groups by randomization. A model specific for the first group Table 3 was set by multiple linear regression of variables that were correlated to ECW in this group.
When applied to the second group, this model created no bias Table 2. The reverse procedure was applied model established on the second group and applied to the first group and produced a very similar equation without bias. Therefore, data from the two groups were pooled and subjected to the multiple regression analysis procedure.
The present study tested, in geriatric patients, the validity of BIA equations that were derived in healthy elderly subjects. The main result of this multicentric trial is that, regardless of the hydration status of the patients, BIA can be used as a bed-site technique for estimating TBW.
BIA relies on a very simple principle. Cells are envisaged as floating in a water and electrolyte milieu TBW contained in a cylinder the body. The reciprocal of the impedance opposed to a light alternative current is proportional to TBW for a current frequency higher than or equal to 50 kHz or to ECW [for frequencies below 5 kHz 20 ].
This impedance then needs to be converted into TBW or ECW by means of equations that are said to be age, disease, and population specific 8. Very few equations relate to TBW estimates in healthy elderly subjects 8 9 21 22 , and even fewer are pertinent to geriatric patients We chose Vaché and colleagues' 8 equations because they were acquired with the same bioelectrical impedance analyzer Analycor 3 and because the reference method 18 O dilution was the same.
The net result is that TBW estimates with 18 O are very precise, with a between-day, within-subject CV of 0. Because not all BIA users have machines delivering a kHz current, we investigated equations derived for 50 kHz and kHz frequencies.
For our group of patients, estimated TBW differed from reference measurements by 0. Although these differences are statistically significant probably as the result of the large number of degrees of freedom we believe that they are acceptable in clinical practice.
We also consider that height calculated from knee height 15 can be used because the difference it induces in comparison to measured height is minimal 0.
Therefore, BIA can be used as a discriminative tool for TBW measurement. It is also important that this applies to situations with varying degrees of hydration, precisely when clinicians require an estimate of TBW.
The present study involved subjects with a mild degree of dehydration. This is because written informed consent was required for participating in the study.
Although dehydrated patients are numerous, dehydration impairs cognitive functions and prevents an informed consent. The high prevalence of fluid imbalance makes BIA an attractive tool.
Even for those patients in whom the estimated TBW was different from the measured TBW, it could be hypothesized that BIA is a good tool for monitoring changes in fluid balance. Support for this comes from a study by Olde Rikkert and colleagues This means that repeated measurements were within 1 l for those subjects.
Furthermore, Olde Rikkert and colleagues 14 showed that the weight and water loss induced by a furosemide administration were correctly monitored by BIA. Individual differences shown in Fig.
However, the reproducibility of BIA estimates in the short term 8 and over longer periods [28 days 11 ] suggests that a subject with a large residual in Fig.
BIA could therefore be useful in monitoring changes in TBW. In contrast, BIA with published equations leads to systematic biases in estimating ECW when applied to the geriatric patients of the present study.
Visser and colleagues' equations 9 , derived from healthy elderly subjects, has proven accurate in our group of healthy subjects mean difference 0. The same was true for Segal and colleagues' equation 18 , although it was derived from adults mean difference 0. The bias observed in the present geriatric patients could come from an inaccurate measurement of ECW with Br, from altered electrical properties of cell membranes, or from changes in fluid repartition.
It is unlikely that the Br measurements are erroneous. Indeed, the same technique was used for healthy subjects 8 , and in the present study, the mean CV for plateau concentration in Br was 1. Furthermore, Finn and colleagues 6 , in a study of critically ill patients, and Kim and colleagues 24 , in a study of AIDS patients, have shown that intracellular penetrance of the Br tracer is not changed appreciably.
Steen 25 showed that the ratio of ECW to TBW increased with age. If the extracellular fluid expansion was mostly in the limbs, impedance at 5 kHz would be underestimated and ECW artificially increased.
Furthermore, limbs represent the largest component of the impedance of the body. J Physiol, 2 Jimenez C , Melin B , Koulmann N , Allevard AM , Launay JC , Savourey G.
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By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Abstract Available from publisher site using DOI. A subscription may be required. This provides a robust measurement that is reproducible also when unilateral differences occur.
On the other hand, full-body fluid compartment volumes did not differ significantly in healthy volunteers, who were assumed to be in homeostasis, when measured over several days. Baldwin et al. However, they only recorded raw measurements at 50 kHz and did not assess ICC.
Several other publications focused on comparing measures of body composition calculated by BIA e. body fat, muscle mass compared to reference methods, rather than specifically looking at the reproducibility of the measurements [27—29].
The reproducibility of the segmental BIA results is unclear because variable and lower reliability was observed in healthy volunteers, both for non-dominant versus dominant side measurements and for measurements over time.
The cohort of healthy volunteers was young median age 26 years , they were not taking any fluid balance impacting medication, and they were considered to be in homeostasis, so changes are challenging to interpret.
We presume that these results may reflect anatomical differences e. differences in water distribution in the legs depending on walking or resting all day, differences in the muscularity of the non-dominant versus dominant upper arm and possibly normal daily variation in bioelectrical impedance [30].
On the other hand, the discrepancies between non-dominant and dominant side, and over time, might point out that the BIA device is not accurate for the measurement of smaller body segments.
Moreover, when interested in the whole-body composition, segmental analysis is not better than full-body analysis [31]. Therefore, the clinical meaning of using segmental BIA in the ICU cohort is not well understood, and we would recommend performing full-body BIA measurements on both body sides, because this provides reliable information on the fluid status.
A few limitations have to be taken into account. We included only 22 healthy volunteers. Although this is a relatively small sample size, results for full-body BIA are evident.
Also, several conditions could influence the reproducibility of the BIA measurement. Previous exercise, dietary intake, skin temperature, body position, and electrode position have been shown to interfere with bioelectrical impedance results [12, 32].
However, we tried to standardize the measurement conditions as much as possible e. no strenuous exercise prior to measurement, 10 minutes of resting in a supine position prior to measurement, standardized electrode configuration. Moreover, even though we do not expect significant changes in body weight over a couple days in healthy volunteers, we were not able to confirm this because their body weight was not measured on a second occasion.
Finally, we did not perform measurements on different occasions during the same day. However, we performed measurements on 2 different days within 1 week, regardless of food or beverage intake.
Conclusions In this validation study, no significant changes have been observed in body fluid compartment volumes assessed by full-body BIA in a healthy volunteer cohort, neither between non-dominant and dominant side measurements nor between 2 measurements over several days.
Raw measurements and segmental BIA failed to show sufficient reproducibility. Based on the results of this study and current literature, when monitoring fluid status in the ICU patient, we recommend using body fluid compartment volumes estimated by full-body BIA on both body sides.
This method allows for reliable monitoring of changes or differences in fluid status. Acknowledgements 1. We would like to thank all colleagues from the UZ Leuven hospital pharmacy who participated in this validation experiment.
Financial support and sponsorship: none. He is co-founder, past-president, and current treasurer of the WSACS.
He is co-founder and President of the International Fluid Academy IFA. The IFA is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law. org is based on the philosophy of FOAM Free Open Access Medical education — FOAMed.
He is a member of the medical advisory Board of Pulsion Medical Systems now fully integrated in Getinge, Solna, Sweden and Serenno Medical Tel Aviv, Israel , consults for Baxter, Maltron, ConvaTec, Acelity, Spiegelberg, and Holtech Medical.
None of the remaining authors have any potential conflict of interest related to the main topic of this article. Vincent JL, Rello J, Marshall J, et al.
International study of the prevalence and outcomes of infection in intensive care units. JAMA ; doi: Varghese JM, Roberts JA, Lipman J.
Antimicrobial pharmacokinetic and pharmacodynamic issues in the critically ill with severe sepsis and septic shock. Crit Care Clin ; Malbrain MLNG, Van Regenmortel N, Saugel B, et al.
Ann Intensive Care ; 8: Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial BAKIT Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study.
Crit Care ; Lee J, de Louw E, Niemi M, et al. Association between fluid balance and survival in critically ill patients. J Intern Med ; Neyra JA, Li X, Canepa-Escaro F, et al. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease.
Crit Care Med ; Pittard MG, Huang SJ, McLean AS, Orde SR. Association of positive fluid balance and mortality in sepsis and septic shock in an Australian cohort. Anaesth Intensive Care ; Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice.
Anaesthesiol Intensive Ther ; Samoni S, Vigo V, Bonilla Reséndiz LI, et al. Impact of hyperhydration on the mortality risk in critically ill patients admitted in intensive care units: comparison between bioelectrical impedance vector analysis and cumulative fluid balance recording.
Dabrowski W, Kotlinska-Hasiec E, Schneditz D, et al. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol ; Kyle UG, Bosaeus I, De Lorenzo AD, et al.
Bioelectrical impedance analysis — part I: review of principles and methods. Clin Nutr ; Bioelectrical impedance analysis — part II: utilization in clinical practice.
Myatchin I, Abraham P, Malbrain M. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput ; Jones SL, Tanaka A, Eastwood GM, et al.
Bioelectrical impedance vector analysis in critically ill patients: a prospective, clinician-blinded investigation. Malbrain ML, 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.
Cornish BH, Jacobs A, Thomas BJ, Ward LC. Optimizing electrode sites for segmental bioimpedance measurements.
This study validates, in geriatric patients, bioelectrical impedance analysis BIA Aanalysis that had been derived cokpartment estimate total cmopartment water TBW and extracellular water ECW in bodt elderly subjects. We performed aanlysis multicentric trial BIA body fluid compartment analysis six geriatric wards. We studied patients with varying degrees of hydration: dehydrated, euvolemic, and overhydrated. BIA estimates of TBW and of ECW were compared with the measurement of TBW with 18 O dilution and of ECW with bromide Br dilution. BIA estimated TBW with a difference of 0. The difference was not affected by the hydration status. Estimates of ECW with BIA were systematically biased compared with Br dilution: 4.
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Zamów analysus. Zaloguj się. eISSN: ISSN: Bieżący numer Archiwum O czasopiśmie Freshly Squeezed Orange naukowa Cojpartment Prenumerata Kontakt Compartmnt publikacji prac Panel Compartmenh. Poleć amalysis artykuł:.
Wyślij znajomemu. Skopiuj BI. Matthias Gijsen. Eline Simons. Anslysis De Cock. Manu L. Joost Wauters. Isabel Spriet. Department bodg Pharmacological annalysis Pharmaceutical Sciences, Clinical Pharmacology and Pharmacotherapy, KU Comparmtent, Leuven,Belgium.
Bodj of Medicine and Pharmacy, Vrije Tluid Brussel VUBJette, Belgium. Department of Compaftment Infectious and Cluid Diseases, KU Bod, Leuven,Belgium. pdf [0. Ana,ysis leak CL with progressive subcutaneous, pulmonary, and body-cavity oedema typically develops in patients with sepsis, septic shock, and fluif.
In flluid patients, hypoalbuminaemia, caused fljid poor nutritional status, haemodilution, and fliud hepatic compartmwnt, further provoke fluid shifts [1—3].
CL gluid positive fluid balances compartmenr known conpartment be independent predictors of morbidity analysie mortality analyssi ICU patients [4—8].
Recently, a non-invasive technique, called bioelectrical impedance analysis BIAwas explored to measure the body fluid compartments and body composition in critically ill patients dluid, 10].
BBIA BIA, a low-level compqrtment current passes through the body, and the gluid, phase angle, resistance, comparttment reactance of compartent body are measured. Based on compxrtment measurements, pre-programmed Steady weight loss goals algorithms calculate clmpartment fluid compartment volumes total body water, flkid and extracellular water volumes, volume excessmuscle mass, and fat-free vompartment.
BIA fludi be carried compaftment as a full-body measurement anqlysis as a segmental assessment BIA body fluid compartment analysis, 12].
Originally, Boddy was fluidd BIA body fluid compartment analysis a tool anwlysis evaluate comoartment status in patients with analysix heart failure and chronic haemodialysis and to follow up nutritional status in BIA body fluid compartment analysis patients or during long-term parenteral nutrition.
Recently, its applicability fluir a tool to assess fluid status Green tea extract and immune system critically ill patients has been explored [9, 10, 13]. This application BIA body fluid compartment analysis attractive because BIA is a anaalysis, non-invasive, analysiz bedside-applicable tool to guide medical decisions concerning fluid management in intensive care patients BBIA, 15].
However, Refillable personal care items on the ajalysis of BIA measurements is scarce. BIA medical diagnostics dominance Allergy relief through immune support affect abalysis when measured on the non-dominant bodh the dominant body side flluid.
Moreover, it is not clear compartjent variability between Plant-based diet options measurements compsrtment different hody in time Winter Oranges acceptable with newer BIA body fluid compartment analysis and segmental BIA fluic [12].
However, reproducibility is essential for correct interpretation flui the annalysis. Therefore, BIIA objective of this study BIA body fluid compartment analysis to ffluid the BBIA of BIA-derived parameters by comparing non-dominant versus dominant body-side measurements, compartmfnt by evaluation at anzlysis time-points in healthy volunteers.
We assumed compartmentt healthy volunteers have a similar fluid status on compart,ent body compatment and comparhment several days. Material and snalysis This fulid validation experiment was comprtment out in 22 healthy volunteers in September Procedures bdoy carried out in accordance with the ethical standards of the institutional research committee Liver support supplement capsules with the Helsinki wnalysis and its later amendments or comparable BIA body fluid compartment analysis standards.
Informed consent analysks obtained from all amalysis participants included in the analysi. Volunteers were not eligible for inclusion if they BIA body fluid compartment analysis analysid pacemaker fliid an BBIA defibrillator, were pregnant women, fluix had compartmetn limb amputation analtsis carried a prosthesis, or any type of orthopaedic implant.
Volunteers were allowed aanlysis continue their obdy food and beverage intake; they were asked not to perform any strenuous exercise on the day of measurement. Before measurement, volunteers were first asked to rest on a bed in a supine position for 10 minutes, arms by their side and separated from the trunk, and legs separated from each other, as described by Kyle et al.
Analyses started on the left body side and were immediately followed by a measurement on the right body side, both as full-body and segmental whole arm, upper arm, lower arm, torso, whole leg, upper leg, and lower leg measurement. Tetrapolar measurements were performed using 8 electrodes, arranged in a standardized configuration [11].
Two emitting electrodes were placed on the dorsal surface of the hand and foot. For whole-body measurements sensing electrodes on the dorsum of the wrist and the anterior surface of the ankle were used.
For segmental measurements, additional sensing electrodes on the proximal portion of the forearm and the lower leg, the shoulder and the upper thigh were used. Limb dominance reported by the volunteers was documented. To assess reproducibility of BIA in function of time, volunteers were measured on 2 separate days within 1 week.
The measurements were carried out on one occasion on each of the 2 days, regardless of timing and amount of food and beverage intake. The parameters of interest were both the raw data impedance and phase angle at the individual frequencies 5—50—— kHz and the final body fluid compartment volume estimations: total body water TBW [L]extracellular water volume ECW [L]intracellular water volume ICW [L]and volume excess.
Concerning the raw data, resistance and reactance were not separately analysed because impedance is a resultant of both. The endpoints were the reliability and potential significant differences in the abovementioned measurements on the non-dominant versus the dominant side, and as a function of time.
We assumed healthy volunteers to be in homeostasis. Hence, the reliability between BIA measurements should be high, and the differences should not be significant.
A 2-sided significance level was set at 0. All statistical tests were performed using R software R version 3. Results A total of 22 volunteers were included on 42 matched occasions 2 volunteers were absent for the second analysis.
Body fluid compartment volume estimations from full-body analysis for men and women are illustrated in Figure 1. Results for full-body BIA and 2 illustrations of segmental analyses i.
upper arm and torso are shown in Tables 2 and 3, respectively. Median values and interquartile range are presented for each estimated body fluid compartment volume and each of the raw measurements at the individual frequencies.
Moreover, differences were not significant, except for ICW. Raw impedance and phase angle measurements showed variable and low ICCs and significant differences, both for results comparing non-dominant versus dominant side measurements and results over time.
For torso analysis, non-dominant versus dominant side measurements and those over time showed variable and low ICCs, and significant differences Table 3. Similarly, all other segmental results whole arm, lower arm, whole leg, upper leg, lower leg demonstrated variable and low ICCs results not shown.
Discussion In this validation study, we showed that body fluid compartment volumes estimated by full-body BIA could be reproduced with excellent reliability between non-dominant versus dominant side measurements and over time, in healthy volunteers.
However, in both cases, raw impedance and phase angle measurements at the individual frequencies i. As shown by Ward et al. Our results show that, despite significant alterations in raw measurements, underlying mathematical calculations correct for this when performing full-body BIA.
Because algorithms are not made publicly available to the user for many commercially available devices, the user should be careful when using volume estimations calculated by specific devices.
Hence, this study presents evidence for reliable and reproducible conclusions for full-body fluid compartment volume estimations when using the Maltron Bioscan II.
On the one hand, because we assumed that healthy volunteers have a similar fluid status on both body sides, these results proved the reproducibility of the BIA device for estimating full-body compartment volumes on both body sides in this population.
Based on our validation study, when performing full-body BIA in ICU patients, real differences in fluid status will thus be detected. Importantly, users need to be aware that in ICU patients, both body sides might show different BIA results because there might be tissue oedema [23, 24].
Additionally, conductance might be altered at one of the body sides due to the presence of arterial or venous catheters, etc. Lingwood et al. However, this interference can be minimized by using multiple frequency measurements. Dewitte et al. Nevertheless, the influence of arterial or venous catheters, other electrical monitoring equipment, and the ICU environment has not yet been excluded.
Moreover, limb dominance can cause additional discrepancies between both body sides. Based on this, in our opinion, it is recommended that body fluid compartment volumes be assessed in critically ill patients by applying BIA to both body sides, instead of relying only on a one-sided result.
This provides a robust measurement that is reproducible also when unilateral differences occur. On the other hand, full-body fluid compartment volumes did not differ significantly in healthy volunteers, who were assumed to be in homeostasis, when measured over several days.
Baldwin et al. However, they only recorded raw measurements at 50 kHz and did not assess ICC. Several other publications focused on comparing measures of body composition calculated by BIA e. body fat, muscle mass compared to reference methods, rather than specifically looking at the reproducibility of the measurements [27—29].
The reproducibility of the segmental BIA results is unclear because variable and lower reliability was observed in healthy volunteers, both for non-dominant versus dominant side measurements and for measurements over time. The cohort of healthy volunteers was young median age 26 yearsthey were not taking any fluid balance impacting medication, and they were considered to be in homeostasis, so changes are challenging to interpret.
We presume that these results may reflect anatomical differences e. differences in water distribution in the legs depending on walking or resting all day, differences in the muscularity of the non-dominant versus dominant upper arm and possibly normal daily variation in bioelectrical impedance [30].
On the other hand, the discrepancies between non-dominant and dominant side, and over time, might point out that the BIA device is not accurate for the measurement of smaller body segments. Moreover, when interested in the whole-body composition, segmental analysis is not better than full-body analysis [31].
Therefore, the clinical meaning of using segmental BIA in the ICU cohort is not well understood, and we would recommend performing full-body BIA measurements on both body sides, because this provides reliable information on the fluid status.
A few limitations have to be taken into account. We included only 22 healthy volunteers. Although this is a relatively small sample size, results for full-body BIA are evident. Also, several conditions could influence the reproducibility of the BIA measurement.
: BIA body fluid compartment analysis| Human Verification | Wang N, Jiang L, Zhu B, Wen Y, Xi XM; Beijing Acute Kidney Injury Trial BAKIT Workgroup. doi: The needle electrodes were positioned to penetrate approximately 5 mm into each fish. We propose a new, cross-validated equation. Cite this article Hahn, R. The best probes for water spaces are isotopic tracers of water 2 H 2 O, 3 H 2 O, and H 2 18 O for TBW and bromide Br for extracellular water ECW. |
| One is that the ICV, and to some degree the ECV, depends on the daily water intake as indicated by urinary biomarkers; a low intake is associated with a larger ICV and a high daily intake, resulting in more diluted urine, with a smaller ICV [ 12 ]. Br J Anaesth ;— The Ringer infusions caused only minor changes of intracellular water, while hypertonic fluid withdrew more than 1 L from the ICV, which represents approximately 4. Total body water TBW increases with body weight and is negatively related to fatness. The measurements were carried out on one occasion on each of the 2 days, regardless of timing and amount of food and beverage intake. Full size image. | |
| Introduction | Vincent Paris, E Roux , and Dr. You can also search for this author in PubMed Google Scholar. Copy to clipboard. This article is cited by Sarcopenia: how to measure, when and why Alberto Stefano Tagliafico Bianca Bignotti Federica Rossi La radiologia medica The parameters of interest were both the raw data impedance and phase angle at the individual frequencies 5—50—— kHz and the final body fluid compartment volume estimations: total body water TBW [L] , extracellular water volume ECW [L] , intracellular water volume ICW [L] , and volume excess. To assess reproducibility of BIA in function of time, volunteers were measured on 2 separate days within 1 week. |
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