Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures
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ORIGINAL ARTICLE
Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures Leslie D. Montgomery • Wayne A. Gerth • Richard W. Montgomery Susie Q. Lew • Michael M. Klein • Julian M. Stewart • Manuel T. Velasquez
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Received: 10 August 2012 / Accepted: 17 March 2013 / Published online: 3 April 2013 Ó International Federation for Medical and Biological Engineering 2013
Abstract The bioimpedance spectroscopic (BIS) analytical algorithm described in this report allows for the noninvasive measurement of intravascular, interstitial, and intracellular volume changes during various fluid management procedures. The purpose of this study was to test clinical use feasibility and to demonstrate the validity of the BIS algorithm in computing compartmental volume shifts in human subjects undergoing fluid management treatment. Validation was performed using volume changes recorded from 20 end stage renal disease patients. The validation procedure involved mathematically deriving post hoc hematocrit profiles from the BIS data-generated fluid redistribution time profiles. These derived hematocrit profiles were then compared to serial hematocrit values measured simultaneously by a CritLineÒ monitor during 60 routine hemodialysis sessions. Regression and Bland–Altman analyses confirm that the BIS algorithm can be used to reliably derive the continuous and real-time rates of change of the compartmental fluid volumes. Regression results yielded a R2 [ 0.99 between the two measures of hematocrit at different times during dialysis. The slopes of the regression equations at the different times were nearly identical, demonstrating an almost one-to-one correspondence
L. D. Montgomery (&) W. A. Gerth R. W. Montgomery LDM Associates, 1764 Emory Street, San Jose, CA 95126, USA e-mail: [email protected] S. Q. Lew M. T. Velasquez George Washington University, Washington, DC, USA M. M. Klein J. M. Stewart New York Medical College, New York, NY, USA
between the BIS and CritLineÒ hematocrits. Bland–Altman analysis show that the BIS algorithm can be used interchangeably with the CritLineÒ monitor for the measurement of hematocrit. The present study demonstrates for the first time that BIS can provide real-time continuous measurements of compartmental intravascular, interstitial and intracellular fluid volume changes during fluid management procedures when used in conjunction with this new algorithm. Keywords Bioimpedance spectroscopy Fluid redistribution Hematocrit Hemodialysis Refill
1 Introduction Hemodynamic redistribution of fluids between body segments and between the fluid compartments within those segments are of central importance to various fluid management procedures [4, 25] and disease states [20, 27–30, 34]. Such fluid redistributions affect the cardiovascular function, water balance and perhaps skeletal muscle function through physiological mechanisms that may be better understood with simultaneous characterization of both the extent and the rate of the inter-compa
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