McGill University, Montreal, QC, Canada.
Clinical Nutrition, Montreal General Hospital, McGill University, Montreal, QC, Canada.
Can J Anaesth. 2019 Dec;66(12):1458-1463. doi: 10.1007/s12630-019-01450-4. Epub 2019 Jul 23.
Bioelectrical impedance analysis (BIA) is a technology that provides a rapid, non-invasive measurement of volume in body compartments and may aid the physician in the assessment of volume status. We sought to investigate the effect of BIA-measured volume status on duration of mechanical ventilation, 28-day mortality, and acute kidney injury requiring renal replacement therapy in a population of medical/surgical patients admitted to the intensive care unit (ICU).
Prospective observational study of adult patients who required mechanical ventilation within 24 hr of admission to ICU. Bioelectrical impedance analysis measured extracellular water (ECW) and total body water (TBW) and these measurements were recorded on days 1, 3, 5, and 7.
A total of 36 patients were enrolled. Mean (standard deviation) age was 61.8 (21.3) years and 31% of patients were female. The majority were admitted from the emergency department or operating room. The most common diagnosis was sepsis. At 28 days, eight patients (22%) had died. There was no association between ECW/TBW ratio at day 1 and 28-day mortality (odds ratio, 1.2; 95% confidence interval [CI], 0.6 to 2.3) after adjusting for age, sex, and Acute Physiology and Chronic Health Evaluation II score. The median [interquartile range] number of ventilator days was 5 [2.5-7.5]. On day 1, for each 1% increase in the ECW/TBW ratio, there was a 1.2-fold increase in ventilator days (95% CI, 1.003 to 1.4; P = 0.05). It is notable that 20% of eligible patients could not be enrolled because medical equipment interfered with correct electrode placement.
Bioimpedance-measured ECW/TBW on day 1 of admission to the ICU is associated with time on the ventilator. While this technology may be a useful adjunct to the clinical assessment of volume status, there are technical barriers to its routine use in a general ICU population.
生物电阻抗分析（BIA）是一种快速、非侵入性的身体容积测量技术，可帮助医生评估容量状态。我们旨在研究生物电阻抗分析测量的容量状态对 ICU 收治的内科/外科患者机械通气时间、28 天死亡率和需要肾脏替代治疗的急性肾损伤的影响。
对 24 小时内需要机械通气的 ICU 入院成年患者进行前瞻性观察性研究。生物电阻抗分析测量细胞外液（ECW）和总体水（TBW），并在第 1、3、5 和 7 天记录这些测量值。
共纳入 36 例患者。患者的平均（标准差）年龄为 61.8（21.3）岁，31%的患者为女性。大多数患者从急诊或手术室转入。最常见的诊断是脓毒症。28 天时，8 例患者（22%）死亡。调整年龄、性别和急性生理学和慢性健康评估 II 评分后，第 1 天的 ECW/TBW 比值与 28 天死亡率之间无相关性（比值比，1.2；95%置信区间 [CI]，0.6 至 2.3）。机械通气天数的中位数[四分位数范围]为 5[2.5-7.5]天。第 1 天，ECW/TBW 比值每增加 1%，机械通气天数增加 1.2 倍（95%CI，1.003 至 1.4；P=0.05）。值得注意的是，由于医疗设备干扰正确的电极放置，20%符合条件的患者无法入组。
ICU 入院第 1 天的生物阻抗测量 ECW/TBW 与呼吸机使用时间相关。虽然这项技术可能是评估容量状态的有用辅助手段，但在普通 ICU 人群中常规使用存在技术障碍。
