Abstract

Purpose

Clinicians lack well-validated, non-invasive, objective tools to guide volume management in the post-resuscitative period. Bioimpedance analysis (BIA) represents a novel method for guiding fluid management. We studied the relationship of BIA vector length (VL), an indicator of volume status, to the need for mechanical ventilation in patients with sepsis.

Methods

This is a multicentre prospective observational study at four Canadian ICUs. We examined adult patients admitted to the ICU within 72 hr of a sepsis diagnosis. Patients underwent daily BIA measurements for 30 days, until discharge from the ICU, or until death. Our primary outcome was the ongoing need for invasive mechanical ventilation, and we examined the association with VL using a generalized estimating equation. Our secondary analyses were targeted to determine an association between VL and other measures of volume status and acute kidney injury (AKI).

Results

We enrolled 159 patients from four centres over 27 months. The mean (standard deviation [SD]) age was 64 (15) yr with a mean (SD) APACHE (acute physiology, age, chronic health evaluation) II score of 25 (10); 57% (n = 91) were male. A 50-unit (ohm·m) increase in VL over any time period was associated with a 30% decrease in the probability of requiring invasive mechanical ventilation (P < 0.03). Volume expansion, indicated by a shorter VL, correlated with higher edema scores (r = − 0.31; P < 0.001) and higher net 24-hr fluid balance (r = − 0.27, P < 0.001). Patients with AKI had a shorter overall VL (r = − 0.23; P = 0.003).

Conclusions

An increase in VL over time is associated with a decrease in probability of requiring invasive mechanical ventilation. Vector length correlates with other commonly used volume assessment methods in post-resuscitation patients with sepsis.

中文翻译：

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使用生物阻抗分析评估重症监护室脓毒症患者复苏后的情况：一项前瞻性多中心观察性研究

 抽象的

 目的

临床医生缺乏经过充分验证的、非侵入性的、客观的工具来指导复苏后的容量管理。生物阻抗分析（BIA）代表了一种指导液体管理的新方法。我们研究了 BIA 矢量长度 (VL)（容量状态指标）与脓毒症患者机械通气需求之间的关系。

 方法

这是在加拿大四个 ICU 进行的一项多中心前瞻性观察研究。我们检查了脓毒症诊断后 72 小时内入住 ICU 的成年患者。患者每天接受 BIA 测量，持续 30 天，直到从 ICU 出院或死亡。我们的主要结果是对有创机械通气的持续需求，并且我们使用广义估计方程检查了与 VL 的关联。我们的二次分析旨在确定 VL 与其他容量状态指标和急性肾损伤 (AKI) 之间的关联。

 结果

我们在 27 个月内招募了来自四个中心的 159 名患者。平均（标准差 [SD]）年龄为 64 (15) 岁，平均 (SD) APACHE（急性生理学、年龄、慢性健康评估）II 评分为 25 (10)； 57% ( n = 91) 为男性。在任何时间段内，VL 增加 50 个单位 (ohm·m) 与需要有创机械通气的可能性降低 30% 相关 ( P < 0.03)。容量扩张（由较短的 VL 表示）与较高的水肿评分（r = − 0.31； P < 0.001）和较高的 24 小时净液体平衡（r = − 0.27， P < 0.001）相关。 AKI 患者的总体 VL 较短（r = − 0.23； P = 0.003）。

 结论

随着时间的推移，VL 的增加与需要有创机械通气的可能性降低相关。矢量长度与脓毒症复苏后患者中其他常用的容量评估方法相关。