Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial

Kai Wang; Shi-Long Sun; Xin-Yu Wang; Cheng-Nan Chu; Ze-Hua Duan; Chao Yang; Bao-Chen Liu; Wei-Wei Ding; Wei-Qin Li; Jie-Shou Li

doi:10.1186/s40779-021-00329-0

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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial

RESEARCH | Updated：2023-02-28

- Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial
- Military Medical Research Vol. 9, Issue 2, Pages: 193-204(2022)
- Affiliations：
  
  1.Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China
  2.Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, the First School of Clinical Medicine, Southern Medical University, Nanjing 210002, China
- Author bio：
  
  * dingwei_nju@hotmail.com;
  njlijieshou@126.com
- Funds：
- DOI：10.1186/s40779-021-00329-0
  CLC：
- Published：2022-04
- Accepted：
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Wang et al.: Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial. Mil Med Res, 2021, 8: 36.
DOI：

Wang et al.: Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial. Mil Med Res, 2021, 8: 36. DOI： 10.1186/s40779-021-00329-0.

摘要

Abstract

Background:

Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore

we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.

Methods:

A pragmatic

prospective

randomized

observer-blind

single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (defined as BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit (ICU) management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC

postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 d after OA. The Kaplan–Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built.

Results:

A total of 134 patients completed the trial (BIA

=66; TRD

=68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33%

. 55.88%

0.001). In the BIA group

the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d (

0.001). Additionally

the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (

0.001) and fewer complications.

Conclusions:

Among postinjury OA patients in the ICU

the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.

关键词

Keywords

references

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