Distribution of water sectors in patients in chronic critical illness: Early rehabilitation stage

BACKGROUND: Fluid therapy in the intensive care unit is not only one of the most common components of therapy but also one of the most controversial and widely discussed. The choice of volume and type of infusion is a multifactorial issue. Currently, the search continues for a convenient non-invasive method that can be used to assess the water composition of the patient’s body.

AIM: To analyze the distribution of fluid sectors in patients with chronic critical illness using bioimpedance with standard fluid therapy.

MATERIALS AND METHODS: The study included 63 patients with chronic critical illness (CCI) after brain damage (men, n=28; women, n=35; average age, 54±19 years). According to nosology, 22 patients had ischemic stroke; 17, traumatic brain injury; 14, hemorrhagic stroke; 7, condition after brain surgery; and 2, post-hypoxic conditions. The study was conducted in the morning before breakfast using the analyzer of bioimpedance metabolic processes and body composition ABC-02 “Medass.” A total of 140 measurements were conducted.

RESULTS: In most cases, the volume of the total body water (TBW) in patients was within the age and sex norm (78.6%); however, the volume of extracellular water (ECW) reached normal values only in 45.7%. Moreover, both indicators were simultaneously within the normal range only in 44.3%. In addition, TBW and ECW did not coincide at 35.7%. The most common option was an increase in ECW while maintaining a normal TBW (24.3%). When conducting a correlation analysis of TBW and ECW indicators with biochemical blood test data (a decrease in the total protein level and albumin level), the strength of the relationship between the correlation coefficients of the samples on the Chaddock scale turned out to be very weak for all options considered.

CONCLUSIONS: In patients in CCI after brain damage, there may be an accumulation of water in the extracellular space without visible edema in >50% of the patients, whereas the TBW indicator is within the age and sex norm in 24.3%. This indicator does not depend on either the level of hypoproteinemia and hypoalbuminemia.