Abstract
Water retention and intercompartmental redistribution occur frequently in association with adverse postoperative outcomes, yet the available strategies for non-invasive assessment are limited. One such approach for evaluating body water composition in various circumstances is bio-electrical impedance analysis (BIA). This study aims to appraise the usefulness of the Body Composition Monitor (BCM, Fresenius Medical Care, Germany) in assessing body fluid composition and intercompartmental shifts before and after open major abdominal surgery. This prospective, clinician blinded observational study enrolled all the patients scheduled consecutively for elective major open abdominal surgery during a 1-year period starting from January 1st, 2016. BIA parameters—total body water (TBW), extracellular water (ECW), intracellular water (ICW), absolute fluid overload (AFO), and relative fluid overload (RFO) were measured before and after surgery. The results were compared with fluid balance and outcome parameters such as organ dysfunction, ICU-and hospital length of stay (-LOS). The study population included 71 patients aged 60.2 ± 12 of whom 60.6% men and with a BMI of 26.3 ± 5.1 kg/m2. Postoperative acute kidney injury, respiratory dysfunction, and infections occurred in 14.0%, 19.7% and 28.1% of cases, respectively. The median LOS in ICU was 20 h and the hospital-LOS was 10 days. Positive intraoperative fluid balance (2.4 ± 1.0 L) resulted in a significant increase of TBW (1.4 ± 2.4 L) and of ECW (1.4 ± 1.2 L). Intraoperative fluid balance significantly correlated with TBW change (r = 0.23, p = 0.04) and with AFO change (r = 0.31, p < 0.01). A significant correlation was found between pre- and postoperative AFO and RFO on one hand, and ICU-LOS on the other. BIA may be a useful tool for the perioperative assessment of volume status.
Highlights
While intraoperative fluid administration is common with patients undergoing surgery, views differ with regard to the type, timing, and volume of the actual intraoperative fluid therapy [1,2,3]
We evaluate the usefulness of the Body Composition Monitor device (BCM, Fresenius Medical Care, Germany) for the assessment of body fluid composition and intercompartmental shifts before and after open major abdominal surgery
Of the 164 patients with elective major open abdominal surgery performed during the aforementioned period, 71 met all the inclusion criteria and were enrolled in the study
Summary
While intraoperative fluid administration is common with patients undergoing surgery, views differ with regard to the type, timing, and volume of the actual intraoperative fluid therapy [1,2,3]. Significant amounts of fluid would be infused during the perioperative period [5, 6] before multiple studies demonstrated that, after major gastrointestinal surgery, excessive intravascular volume may increase postoperative morbidity and mortality while judicious perioperative fluid therapy may improve outcomes [3, 5,6,7,8]. Journal of Clinical Monitoring and Computing (2020) 34:421–432 therapy (GDT) protocol in which specific hemodynamic targets guide fluid and vasoactive drug administration has the potential to lessen postoperative complications [9, 10]. Such an approach may result in infusing larger volumes compared to standard care [9]. The ROSE concept of the four fluid phases (resuscitation, optimization, stabilization, and evacuation) may help inform and optimize fluid therapy [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
