A Protective Fluid Resuscitation Strategy In HF Patients With Sepsis Does Not Significantly Influence Mortality
HFSA ePoster Library. Wong A. 09/10/21; 343641; 82
Dr. Alan Wong
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Abstract
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Background: Evaluating volume status adequately remains a challenge to most practitioners. Following heart failure (HF) hospitalization, patients often are discharged on an increased diuretic regimen with uncertainty around how long it will take for a patient to reach true decongestion. Resolution of symptoms, weight monitoring, and peripheral edema are not always true indicators of a patient's current volume status. Bioimpedance Spectroscopy (BIS) has been shown to accurately measure extracellular fluid (ECF) and correlates well with bromide dilution (gold standard method). Reducing ECF is the main objective of diuretic therapy.
Methods: Patients with NYHA Class II or III HF were enrolled in a multi-center observational study. Initial BIS measurement and body weight was obtained 48-72 hours following HF hospital discharge and measured daily thereafter. We report on 69 patients each of whom had between 30 and 90 days of monitoring post-discharge. Daily ECF and weight results were not made available to treating providers.
Results: Time to ECF nadir was 16.9 + 15.9 days (mean + SD), range 0 to 62.9 days. ECF loss from initial measurement to nadir was 2.2 + 1.9 liters, range 0 to 9.65 liters; ECF loss on a percentage basis was 10.3% + 7.4%, range 0% to 32.6%. Time to weight nadir was 18.1 + 15.5 days, range 0 to 49.9 days. Weight loss from initial measurement to nadir was 3.6 + 3.9 kg, range 0 to 18.5 kg. Weight loss on a percentage basis was 4.5% + 5.1%, range 0% to 28.7% and was significantly lower than the corresponding measure for ECF [median weight loss of 3.4% (95% CI: 2.1-4.2%) versus median ECF loss of 7.8% (95% CI: 6.7-10.4%), p<0.0001 by Wilcoxon test].
Conclusion: Daily noninvasive BIS measurements may assist in tracking fluid status in HF patients post-discharge from HF hospitalization. The more than two-fold ECF loss as compared to weight loss on a percentage basis (p<0.0001) demonstrates the sensitivity of BIS as diuretic decongestion reduces the ECF sub-compartment of overall body weight. Frequent monitoring of ECF may help guide diuretic therapy after HF hospitalization by focusing on the therapeutic target of interest. Time required to achieve clinical decongestion is highly variable and often takes longer than may be anticipated (average of 16.9 days).
Methods: Patients with NYHA Class II or III HF were enrolled in a multi-center observational study. Initial BIS measurement and body weight was obtained 48-72 hours following HF hospital discharge and measured daily thereafter. We report on 69 patients each of whom had between 30 and 90 days of monitoring post-discharge. Daily ECF and weight results were not made available to treating providers.
Results: Time to ECF nadir was 16.9 + 15.9 days (mean + SD), range 0 to 62.9 days. ECF loss from initial measurement to nadir was 2.2 + 1.9 liters, range 0 to 9.65 liters; ECF loss on a percentage basis was 10.3% + 7.4%, range 0% to 32.6%. Time to weight nadir was 18.1 + 15.5 days, range 0 to 49.9 days. Weight loss from initial measurement to nadir was 3.6 + 3.9 kg, range 0 to 18.5 kg. Weight loss on a percentage basis was 4.5% + 5.1%, range 0% to 28.7% and was significantly lower than the corresponding measure for ECF [median weight loss of 3.4% (95% CI: 2.1-4.2%) versus median ECF loss of 7.8% (95% CI: 6.7-10.4%), p<0.0001 by Wilcoxon test].
Conclusion: Daily noninvasive BIS measurements may assist in tracking fluid status in HF patients post-discharge from HF hospitalization. The more than two-fold ECF loss as compared to weight loss on a percentage basis (p<0.0001) demonstrates the sensitivity of BIS as diuretic decongestion reduces the ECF sub-compartment of overall body weight. Frequent monitoring of ECF may help guide diuretic therapy after HF hospitalization by focusing on the therapeutic target of interest. Time required to achieve clinical decongestion is highly variable and often takes longer than may be anticipated (average of 16.9 days).
Background: Evaluating volume status adequately remains a challenge to most practitioners. Following heart failure (HF) hospitalization, patients often are discharged on an increased diuretic regimen with uncertainty around how long it will take for a patient to reach true decongestion. Resolution of symptoms, weight monitoring, and peripheral edema are not always true indicators of a patient's current volume status. Bioimpedance Spectroscopy (BIS) has been shown to accurately measure extracellular fluid (ECF) and correlates well with bromide dilution (gold standard method). Reducing ECF is the main objective of diuretic therapy.
Methods: Patients with NYHA Class II or III HF were enrolled in a multi-center observational study. Initial BIS measurement and body weight was obtained 48-72 hours following HF hospital discharge and measured daily thereafter. We report on 69 patients each of whom had between 30 and 90 days of monitoring post-discharge. Daily ECF and weight results were not made available to treating providers.
Results: Time to ECF nadir was 16.9 + 15.9 days (mean + SD), range 0 to 62.9 days. ECF loss from initial measurement to nadir was 2.2 + 1.9 liters, range 0 to 9.65 liters; ECF loss on a percentage basis was 10.3% + 7.4%, range 0% to 32.6%. Time to weight nadir was 18.1 + 15.5 days, range 0 to 49.9 days. Weight loss from initial measurement to nadir was 3.6 + 3.9 kg, range 0 to 18.5 kg. Weight loss on a percentage basis was 4.5% + 5.1%, range 0% to 28.7% and was significantly lower than the corresponding measure for ECF [median weight loss of 3.4% (95% CI: 2.1-4.2%) versus median ECF loss of 7.8% (95% CI: 6.7-10.4%), p<0.0001 by Wilcoxon test].
Conclusion: Daily noninvasive BIS measurements may assist in tracking fluid status in HF patients post-discharge from HF hospitalization. The more than two-fold ECF loss as compared to weight loss on a percentage basis (p<0.0001) demonstrates the sensitivity of BIS as diuretic decongestion reduces the ECF sub-compartment of overall body weight. Frequent monitoring of ECF may help guide diuretic therapy after HF hospitalization by focusing on the therapeutic target of interest. Time required to achieve clinical decongestion is highly variable and often takes longer than may be anticipated (average of 16.9 days).
Methods: Patients with NYHA Class II or III HF were enrolled in a multi-center observational study. Initial BIS measurement and body weight was obtained 48-72 hours following HF hospital discharge and measured daily thereafter. We report on 69 patients each of whom had between 30 and 90 days of monitoring post-discharge. Daily ECF and weight results were not made available to treating providers.
Results: Time to ECF nadir was 16.9 + 15.9 days (mean + SD), range 0 to 62.9 days. ECF loss from initial measurement to nadir was 2.2 + 1.9 liters, range 0 to 9.65 liters; ECF loss on a percentage basis was 10.3% + 7.4%, range 0% to 32.6%. Time to weight nadir was 18.1 + 15.5 days, range 0 to 49.9 days. Weight loss from initial measurement to nadir was 3.6 + 3.9 kg, range 0 to 18.5 kg. Weight loss on a percentage basis was 4.5% + 5.1%, range 0% to 28.7% and was significantly lower than the corresponding measure for ECF [median weight loss of 3.4% (95% CI: 2.1-4.2%) versus median ECF loss of 7.8% (95% CI: 6.7-10.4%), p<0.0001 by Wilcoxon test].
Conclusion: Daily noninvasive BIS measurements may assist in tracking fluid status in HF patients post-discharge from HF hospitalization. The more than two-fold ECF loss as compared to weight loss on a percentage basis (p<0.0001) demonstrates the sensitivity of BIS as diuretic decongestion reduces the ECF sub-compartment of overall body weight. Frequent monitoring of ECF may help guide diuretic therapy after HF hospitalization by focusing on the therapeutic target of interest. Time required to achieve clinical decongestion is highly variable and often takes longer than may be anticipated (average of 16.9 days).
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