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Bioimpedance spectroscopy for assessment of volume status in patients before and after general anaesthesia.

Ernstbrunner M, Kostner L, Kimberger O, Wabel P, Säemann M, Markstaller K, Fleischmann E, Kabon B, Hecking M - PLoS ONE (2014)

Bottom Line: Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r(2) = 0.65), but was not associated with change in intracellular volume (r(2) = 0.01).Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment.BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.

View Article: PubMed Central - PubMed

Affiliation: Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria.

ABSTRACT

Background: Technically assisted assessment of volume status before surgery may be useful to direct intraoperative fluid administration. We therefore tested a recently developed whole-body bioimpedance spectroscopy device to determine pre- to postoperative fluid distribution.

Methods: Using a three-compartment physiologic tissue model, the body composition monitor (BCM, Fresenius Medical Care, Germany) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of 'normal' extracellular volume. BCM-measurements were performed before and after standardized general anaesthesia for gynaecological procedures (laparotomies, laparoscopies and vaginal surgeries). BCM results were blinded to the attending anaesthesiologist and data analysed using the 2-sided, paired Student's t-test and multiple linear regression.

Results: In 71 females aged 45 ± 15 years with body weight 67 ± 13 kg and Duration of anesthesia 154 ± 69 minutes [corrected] duration of anaesthesia 154 ± 68 min, pre- to postoperative fluid overload increased from -0.7 ± 1.1 L to 0.1 ± 1.0 L, corresponding to -5.1 ± 7.5% and 0.8 ± 6.7% of normal extracellular volume, respectively (both p<0.001), after patients had received 1.9 ± 0.9 L intravenous crystalloid fluid. Perioperative urinary excretion was 0.3 ± 0.2 L [corrected]. The increase in extracellular volume was paralleled by an increase in total body fluid volume, while intracellular volume increased only slightly and without reaching statistical significance (p = 0.15). Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r(2) = 0.65), but was not associated with change in intracellular volume (r(2) = 0.01).

Conclusions: Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment. BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.

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Related in: MedlinePlus

Associations between pre- to postoperative changes in volume status and net perioperative fluid balance.Scatter plots. Regression equations are as follows: A Change in Extracellular Volume = 0.73×Net Perioperative Fluid Balance –0.37. B Change in Total Body volume = 0.91×Net Perioperative Fluid Balance –0.43. C No linear correlation between Change in Intracellular Volume and Net Perioperative Fluid Balance. D No linear correlation between Change in Intracellular Volume and Change in Extracellular Volume. Pearson correlation test. R2 = Coefficient of determination.
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pone-0111139-g001: Associations between pre- to postoperative changes in volume status and net perioperative fluid balance.Scatter plots. Regression equations are as follows: A Change in Extracellular Volume = 0.73×Net Perioperative Fluid Balance –0.37. B Change in Total Body volume = 0.91×Net Perioperative Fluid Balance –0.43. C No linear correlation between Change in Intracellular Volume and Net Perioperative Fluid Balance. D No linear correlation between Change in Intracellular Volume and Change in Extracellular Volume. Pearson correlation test. R2 = Coefficient of determination.

Mentions: We evaluated the relationship between perioperative fluid administration and changes in pre- to postoperative fluid status and identified a strong, significant correlation between the net perioperative fluid balance and change in ECV (r2 = 0.65, p<0.001, Figure 1A). We also identified a significant correlation between the net perioperative fluid balance and change in TBV, however, the coefficient of determination was smaller (r2 = 0.22, p<0.001, Figure 1B). Net perioperative fluid balance, respectively change in ECV were not significantly associated with change in ICV (Figure 1C and 1D).


Bioimpedance spectroscopy for assessment of volume status in patients before and after general anaesthesia.

Ernstbrunner M, Kostner L, Kimberger O, Wabel P, Säemann M, Markstaller K, Fleischmann E, Kabon B, Hecking M - PLoS ONE (2014)

Associations between pre- to postoperative changes in volume status and net perioperative fluid balance.Scatter plots. Regression equations are as follows: A Change in Extracellular Volume = 0.73×Net Perioperative Fluid Balance –0.37. B Change in Total Body volume = 0.91×Net Perioperative Fluid Balance –0.43. C No linear correlation between Change in Intracellular Volume and Net Perioperative Fluid Balance. D No linear correlation between Change in Intracellular Volume and Change in Extracellular Volume. Pearson correlation test. R2 = Coefficient of determination.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215896&req=5

pone-0111139-g001: Associations between pre- to postoperative changes in volume status and net perioperative fluid balance.Scatter plots. Regression equations are as follows: A Change in Extracellular Volume = 0.73×Net Perioperative Fluid Balance –0.37. B Change in Total Body volume = 0.91×Net Perioperative Fluid Balance –0.43. C No linear correlation between Change in Intracellular Volume and Net Perioperative Fluid Balance. D No linear correlation between Change in Intracellular Volume and Change in Extracellular Volume. Pearson correlation test. R2 = Coefficient of determination.
Mentions: We evaluated the relationship between perioperative fluid administration and changes in pre- to postoperative fluid status and identified a strong, significant correlation between the net perioperative fluid balance and change in ECV (r2 = 0.65, p<0.001, Figure 1A). We also identified a significant correlation between the net perioperative fluid balance and change in TBV, however, the coefficient of determination was smaller (r2 = 0.22, p<0.001, Figure 1B). Net perioperative fluid balance, respectively change in ECV were not significantly associated with change in ICV (Figure 1C and 1D).

Bottom Line: Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r(2) = 0.65), but was not associated with change in intracellular volume (r(2) = 0.01).Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment.BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.

View Article: PubMed Central - PubMed

Affiliation: Medical University of Vienna, Department of Anaesthesiology and Critical Care Medicine, Vienna, Austria.

ABSTRACT

Background: Technically assisted assessment of volume status before surgery may be useful to direct intraoperative fluid administration. We therefore tested a recently developed whole-body bioimpedance spectroscopy device to determine pre- to postoperative fluid distribution.

Methods: Using a three-compartment physiologic tissue model, the body composition monitor (BCM, Fresenius Medical Care, Germany) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of 'normal' extracellular volume. BCM-measurements were performed before and after standardized general anaesthesia for gynaecological procedures (laparotomies, laparoscopies and vaginal surgeries). BCM results were blinded to the attending anaesthesiologist and data analysed using the 2-sided, paired Student's t-test and multiple linear regression.

Results: In 71 females aged 45 ± 15 years with body weight 67 ± 13 kg and Duration of anesthesia 154 ± 69 minutes [corrected] duration of anaesthesia 154 ± 68 min, pre- to postoperative fluid overload increased from -0.7 ± 1.1 L to 0.1 ± 1.0 L, corresponding to -5.1 ± 7.5% and 0.8 ± 6.7% of normal extracellular volume, respectively (both p<0.001), after patients had received 1.9 ± 0.9 L intravenous crystalloid fluid. Perioperative urinary excretion was 0.3 ± 0.2 L [corrected]. The increase in extracellular volume was paralleled by an increase in total body fluid volume, while intracellular volume increased only slightly and without reaching statistical significance (p = 0.15). Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r(2) = 0.65), but was not associated with change in intracellular volume (r(2) = 0.01).

Conclusions: Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment. BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.

Show MeSH
Related in: MedlinePlus