Fp263a Comparison Between Bioimpedance Data, Lung Ultrasonography and Fluid Acccumulation. Three Cards to Determinate the State of Euvolemia and Fluid Overload in Critical Ill Patients
Year: 2018
Type: conference-abstract
Abstract: INTRODUCTION AND AIMS: Fluid overload has been associated with organ dysfunction and an increase of mortality. Currently, reliable measurements of overhydration are not available that allow an adequate adjustment of fluids, which becomes of special difficulty in critical ill patients.We aimed to study the association between lung ultrasonography, bioimpedance spectroscopy (BIS) and fluid accumulation (using graphics of intensive care unit (ICU) and their relathionship with support treatment, mortality and length of stay. METHODS: We conducted a prospective observational cohort study using a cohort of 57 patients of a ICU during six months comparising trhee different measurements of overhydration: three bioimpedances (admission, 48 h and in the end of ICU staying), three lung ultrasound (using B-Lines) and fluid accumulation. We collected data on patient characteristics, length of stay and ICU and in-hospital mortality We excluded patients with respiratory distress syndrome (ARDS), thoracic surgery and patients with prostheses. RESULTS: We included 57 patients (58.9% men, mean age of 61.58 years). Admission diagnosis in ICU: hydroelectrolitic disease (1.8%); low level of consciousness (21.1%); respiratory failure (10.5%); sepsis (36.8%); 10,5% surgery (10.5%) other diagnosis (19.3%). Hyperthension (70.2%), diabetes (26.3%), dyslipemia (49.3%), end stage of renal disease without dialysis (8.8%), end stage of renal disease with dialysis 12.3 % , AKI (70%), mechanical ventilation (33.3 %), vasoactives (36.8%) ICU mortality (5.4%), in-hospital mortality (14.3 %). APACHE II (17), baseline creatinine (1.97), PCR (115), albumine (2.89), mean fluid overload (+1826.88 ml), mean OH (+2.5), mean LUS (22.5), AKI at the end of staying in UCI (23.2%). We made statistical anlysis by the measurements of overhydration, and the rest of outcomes, There was no relationship between measured overhydration (fluid accumulation, LUS and BIS) and mortality, but there was a relationship (p<0.05) between overhydration measured by LUS and the need for mechanical ventilation. A relationship was found between fluid overload measured by fluid accumulation (p <0.05) and the need for vasoactive drugs. It was evidenced that patients who presented greater overhydration, measured by bioimpedance on the last day of admission to the ICU, had more AKI at discharge (p <0.05).Finally, no correlation was found between overhydration, measured by BIS or LUS, with fluid accumulation. CONCLUSIONS: The use of lung ultrasound can be an useful instrument for assessing the volemia and hydration status of the critical ill patient, because it is a simple, cost / effective, non-radiant, reproducible test with high sensitivity. However, for its correct validation, more studies with larger sample sizes are needed, such as the BIOECO study, with an N (expected) = 385 patients, which we believe, yields significant results for the validation of this technique.
Institution: Complejo Hospitalario Universitario de Albacete
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2803776008