INTENSIVE CARE UNIT

Make better nutrition assessment, and identify fluid imbalance

to predict mortality of the patient.

Why is body composition analysis

an effective tool in intensive care?

Disclaimer: InBody devices should be used as an adjunct tool for clinical decision making and are not intended to diagnose or treat any diseases. ​

Body composition obtained via bioelectrical impedance is important for understanding a patient’s fluid status and physiological makeup to be used for guiding treatments aimed at improving patient status, decreasing the length of hospital stay, and reducing the risk of mortality. InBody devices are non-invasive and convenient, making them ideal for implementing into the ICU for patient assessments. The InBody Test produces comprehensive results that physicians can use to monitor fluid levels and health to improve patient outcomes. InBody provides a cost-effective strategy in a highly complex personalized care setting.​

In less than 60 seconds, the InBody Test provides easy-to-understand, accurate and objective measurements to evaluate the patient’s health upon ICU admittance and for monitoring progress throughout the hospital stay. Physicians can use the InBody to:​

  • Identify fluid imbalances related to medical conditions, trauma or organ failure​

  • Track fluid overload and management​

  • Monitor body composition variables for muscle loss and cachexia​

  • Assess risk of malnutrition

ECW RATIO ANALYSIS

Find objective measures of body water to promote better patient outcomes

Many patients admitted to the ICU arrive overhydrated, which is deleterious to their prognosis. However, current clinical methods of fluid volume assessment are indirect and cannot accurately quantify body water. ​

InBody provides objective measures of body water, enabling critical care professionals to appropriately assess fluid status.
​
Management of fluid balance is one of the main priorities in an ICU. While fluid imbalance can be a result of trauma, organ failure, sepsis, or other major injuries, all causes of fluid overload lead to poor patient outcomes, including delayed recovery, increased length of stay, and higher rates of morbidity and mortality. ​

Current methods of fluid assessment in the ICU such as blood pressure, pitting edema, and body weight measures are indirect and subjective, making them difficult to interpret for streamlined clinical decision making. Thus, an effective tool for the noninvasive measurement of body water distribution is necessary to quantify the extent of edema in patients in the ICU. ​

InBody effectively distinguishes water in the intracellular (ICW; within the tissues) and extracellular (ECW; within the blood and interstitial fluids) compartments that comprise total body water. The Edema Index, based on the ratio between ECW and TBW (ECW/TBW), allows intensive care professionals to objectively measure and monitor disease-related fluid accumulation in their patients and identify imbalances stemming from edema. Because fluid overload can lead to respiratory complications, cardiac failure, and other life-threatening conditions, early evaluation of fluid status is crucial for treatment success. Quick, precise quantification and assessment of body water can help guide treatment plans to resolve fluid overload. Thus, measurement of whole body and segmental ECW/TBW allows health professionals to better assess their patients’ conditions and current fluid status, leading to more efficient clinical decision-making and improved fluid management to promote better patient outcomes.​

SEGMENTAL ECW RATIO ANALYSIS

Use fluid balance to monitor intervention and improve treatment

Intensive care professionals have difficulty managing fluid overload, decreasing the success of fluid management as well as patient outcomes. ​

InBody provides objective measures for quantifying changes in fluid status and guiding treatment strategies for better management of ICU patients. ​

Effective management of fluid status is crucial for patient success in the ICU. ​

However, this is often challenging as clinicians must constantly balance the effects of large amounts of fluid administration as well as fluid removal. ​ By monitoring changes in each fluid compartment as well as ECW/TBW, intensive care professionals will be able to assess the efficacy of different treatment strategies and make appropriate adjustments to improve fluid management. For example, measurement of fluid status after initial use of diuretics provides direct feedback to the critical care professional, allowing them to better evaluate the effectiveness of the therapy or to determine whether alternative methods, such as continuous renal replacement therapy (CRRT), are necessary. By tracking objective measures of body water throughout treatment, clinicians will increase success in achieving optimal fluid balance with each patient, leading to better outcomes and survival.​

Successful management of fluid status eliminates many complications associated with poor fluid balance. Patients who are overhydrated spend more time on ventilation and have higher rates of mortality compared to euvolemic subjects. Through proper fluid management and other ICU therapies, improving patient outcomes and reducing clinic costs. Equipped with comprehensive data on body water and fluid balance, critical care professionals will be able to tailor drug therapies and other treatment plans to manage edema in their patients, shorten the length of ICU stay as well as reduce mortaility risk. ​

SEGMENTAL LEAN ANALYSIS AND MUSCLE-FAT ANALYSIS

Gain an in-depth analysis on body composition to improve recovery and prognosis

Patients who are forbidden or in critical care experience significant muscle loss, leading to decreased physical function and poor long-term outcomes after discharge. ​

InBody allows for frequent and reliable testing to monitor changes in body composition, including muscle and fat balance, to guide patient care programs towards preserving lean mass and mobility.​

Significant losses of fat-free mass can occur within two days of bed rest in the ICU. In addition to prolonged bed rest, inflammatory processes and treatments, such as sedation, further contribute to muscle and bone catabolism. This impacts functional ability, which can delay full recovery and have long-term effects on cognitive health and survival. Maintaining lean mass has been linked to improved recovery and prognosis for patients in the ICU, thus proper nutrition and early mobilization are necessary strategies to prevent muscle depletion in the ICU setting.​

InBody’s Segmental Lean Analysis (SLA) allows critical care professionals to monitor fat-free mass and ECW/TBW values in each segment of the body, providing an in-depth analysis on body composition, elucidating where musculature may be deficient, decreasing, or requiring improvement. In addition to segmental distribution, monitoring both lean mass and body water values helps guide treatments and provides a better understanding of unintentional weight loss. This serves as a more direct measure for effectively distinguishing weight fluctuations resulting from changes in fluid or muscle-fat balance. ​

PHASE ANGLE

Diagnose malnutrition for monitoring nutritional status in the ICU by subjective assessment and conventional methods of tracking changes in body weight.

Malnutrition is often underdiagnosed in the ICU by subjective assessments and conventional method of tracking changes in body weight.

InBody provides a detailed analysis of body composition, along with phase angle, which has been shown as a useful tool in the diagnosis of malnutrition for monitoring nutritional status in the ICU. ​

Malnutrition is common in the ICU and can contribute to delayed recovery and poor clinical outcomes, including increased length of stay, lower survival, and higher costs. Early identification and intervention are key to improving patient outcomes and preventing readmission or mortality after discharge. While critically ill patients are provided various forms of nutrition therapy, absorption of nutrients is often dependent upon the condition of the patient, Without proper absorption, nutritional status worsens and treatment malnutrition through the monitoring of Phase Angle is an important strategy for improving clinical outcomes. ​

Phase Angle is a measure of cellular resistivity and reflects cell membrane integrity and overall cellular health. As a sensitive marker of malnutrition, Phase Angle can be used to detect subclinical changes in nutritional status related to changes in body composition caused by muscle catabolism or fluid overload. A strong positive association between Phase Angle and nutritional screening tools, such as the Subjective Global Assessment, as well as various markers of nutritional risk has been well established. Additionally, the European Society for Parenteral and Enteral Nutrition (ESPEN) acknowledges its prognostic value in patients requiring nutritional therapy – a lower Phase Angle at intake has been linked to worsened outcomes in ICU patients, while a higher Phase Angle is associated with increased survival rates. By monitoring a patient’s Phase Angle, critical care professionals can noninvasively evaluate nutritional status. ​

Fig. 1. Covariate-adjusted ROC curves for Bia values (Reactance, Impedance and Wholebody phase angle) and severity scorings (APACHE ll, SOFA, and SAPS lll) as mortality predictive tools.
(Adjusted values; age, gender, BMI)

Use of Bioelectrical Impedance Analysis for the Assessment of Nutritional Status in Critically Ill Patients

Lee, Y., Kwon, O., Shin, C. S., & Lee, S. M. (2015). Use of bioelectrical impedance analysis for the assessment of nutritional status in critically ill patients. Clinical nutrition research, 4(1), 32-40.

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