TY - JOUR

T1 - Bioimpedance as a measure of fluids in patients with septic shock. A prospective observational study

AU - Madsen, Janne M

AU - Itenov, Theis S

AU - Koch, Ellen Bjerre

AU - Bestle, Morten H

N1 - This article is protected by copyright. All rights reserved.

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Septic shock is often treated with aggressive fluid resuscitation leading to profound fluid overload. The assessment of fluid status relies on suboptimal measures making treatment difficult. Bioelectrical impedance analysis is an alternative but the validity is unclear. The aim of this study was to determine the validity of bioelectrical impedance analysis for fluid measures in patients with septic shock.METHODS: Single-center, prospective observational cohort study. We included adult ICU patients with septic shock. We evaluated the agreement between measures on the left and right side of the patient and measures one hour apart by two bioelectrical impedance devices. Results are presented as Bland Altman plots with 95% Limits of Agreements (LoA) and as correlations between bioelectrical impedance analysis results and clinical markers of fluids.RESULTS: 49 patients were included. The agreement between measures on the left and the right side of the patient and after one hour was overall without bias, but with wide LoA's. Fluid overload one hour apart showed the most narrow 95% LoA (-2.4l - 2.9L). The same wide limits of agreements were observed when comparing devices. E.g. total body water with 95% LoA of -14.8l - 16.7l. Correlations between bioelectrical impedance analysis and clinical measures were low but statistically significant.CONCLUSIONS: In patients with septic shock bioelectrical impedance analysis had no systematic errors or bias, but wide limits of agreement, indicating that the devices have a large and uncorrectable random error. Fluid status by bioelectrical impedance analysis is not sufficiently accurate to guide treatment in this group of patients. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: Septic shock is often treated with aggressive fluid resuscitation leading to profound fluid overload. The assessment of fluid status relies on suboptimal measures making treatment difficult. Bioelectrical impedance analysis is an alternative but the validity is unclear. The aim of this study was to determine the validity of bioelectrical impedance analysis for fluid measures in patients with septic shock.METHODS: Single-center, prospective observational cohort study. We included adult ICU patients with septic shock. We evaluated the agreement between measures on the left and right side of the patient and measures one hour apart by two bioelectrical impedance devices. Results are presented as Bland Altman plots with 95% Limits of Agreements (LoA) and as correlations between bioelectrical impedance analysis results and clinical markers of fluids.RESULTS: 49 patients were included. The agreement between measures on the left and the right side of the patient and after one hour was overall without bias, but with wide LoA's. Fluid overload one hour apart showed the most narrow 95% LoA (-2.4l - 2.9L). The same wide limits of agreements were observed when comparing devices. E.g. total body water with 95% LoA of -14.8l - 16.7l. Correlations between bioelectrical impedance analysis and clinical measures were low but statistically significant.CONCLUSIONS: In patients with septic shock bioelectrical impedance analysis had no systematic errors or bias, but wide limits of agreement, indicating that the devices have a large and uncorrectable random error. Fluid status by bioelectrical impedance analysis is not sufficiently accurate to guide treatment in this group of patients. This article is protected by copyright. All rights reserved.

U2 - 10.1111/aas.14180

DO - 10.1111/aas.14180

M3 - Journal article

C2 - 36537040

VL - 67

SP - 319

EP - 328

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 3

ER -