Name: evaluation of fluid overload by bioelectrical impedance vectorial analysis
Uploaded: 2022-08-17T14:40:00
Description: Watch this Scientific Journal Video about Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis at JoVE.com

The authors would like to thank Prof(s). Piccoli and Pastori of the Department of Medical and Surgical Sciences, University of Padova, Italy, for providing the BIVA software. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The following protocol was approved (REF. 3057) and follows the guidelines of the human research ethics committee of Instituto Nacional de Ciencias M&#233;dicas y Nutrici&#243;n SZ. Furthermore, prior consent was obtained from the patients for this study.
NOTE: This procedure is to be used for measuring bioelectrical impedance analysis using tetrapolar multi-frequency equipment (see Table of Materials) and will provide accurate resistance and reactance values at a single frequ...

<ol>
	<li>da Silva, A. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+hyperhydration+evaluated+by+bioelectrical+impedance+analysis+and+mortality+in+patients+with+different+medical+conditions:+Systematic+review+and+meta-analyses.+Clinical+Nutrition+ASPEN+Association+of+hyperhydration+evaluated+by+bioelectrical.">Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses. Clinical Nutrition ASPEN Association of hyperhydration evaluated by bioelectrical.</a> Clinical Nutrition ESPEN. 28, 12-20 (2018).</li><li>Kammar-Garc&#237;a, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Bioelectrical+Impedance+Analysis+parameters+for+the+detection+of+fluid+overload+in+the+prediction+of+mortality+in+patients+admitted+at+the+emergency+department.">Comparison of Bioelectrical Impedance Analysis parameters for the detection of fluid overload in the prediction of mortality in patients admitted at the emergency department.</a> Journal of Parenteral and Enteral Nutrition. 45 (2), 414-422 (2021).</li><li>Kammar-Garc&#237;a, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SOFA+score+plus+impedance+ratio+predicts+mortality+in+critically+ill+patients+admitted+to+the+emergency+department:+Retrospective+observational+study.">SOFA score plus impedance ratio predicts mortality in critically ill patients admitted to the emergency department: Retrospective observational study.</a> Healthcare (Basel). 10 (5), 810 (2022).</li><li>Frank Peacock, W., Soto, K. 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C., Piccoli, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+Impedance+Vector+Analysis+for+Assessment+of+Hydration+in+Physiological+States+and+Clinical+Conditions.">Bioelectrical Impedance Vector Analysis for Assessment of Hydration in Physiological States and Clinical Conditions.</a> Handbook of Anthropometry. , 287-305 (2012).</li><li>Piccoli, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bivariate+normal+values+of+the+bioelectrical+impedance+vector+in+adult+and+elderly+populations.">Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations.</a> The American Journal of Clinical Nutrition. 61 (2), 269-270 (1995).</li><li>Roubenoff, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+bioelectrical+impedance+analysis+to+elderly+populations.">Application of bioelectrical impedance analysis to elderly populations.</a> The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 52 (3), 129-136 (1997).</li><li>Espinosa-Cuevas, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bio+impedance+vector+an&#225;lisis+for+body+composition+in+Mexican+population.">Bio impedance vector an&#225;lisis for body composition in Mexican population.</a> Revista de Investigaci&#243;n Cl&#237;nica. 59 (1), 15-24 (2007).</li><li>Demirci, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impedance+ratio:+a+novel+marker+and+a+power+predictor+of+mortality+in+hemodialysis+patients.">Impedance ratio: a novel marker and a power predictor of mortality in hemodialysis patients.</a> International Urology and Nephrology. 48 (7), 1155-1162 (2016).</li><li>Plank, L. D., Li, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioimpedance+illness+marker+compared+to+phase+angle+as+a+predictor+of+malnutrition+in+hospitalized+patients.">Bioimpedance illness marker compared to phase angle as a predictor of malnutrition in hospitalized patients.</a> Clinical Nutrition. 32, 85 (2013).</li><li>Castillo-Martinez, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+and+strength+measurements+in+patients+with+heart+failure:+comparison+with+functional+class.">Bioelectrical impedance and strength measurements in patients with heart failure: comparison with functional class.</a> Nutrition. 23 (5), 412-418 (2007).</li><li>Earthman, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Body+composition+tools+for+assessment+of+adult+malnutrition+at+the+bedside:+A+tutorial+on+research+considerations+and+clinical+applications.">Body composition tools for assessment of adult malnutrition at the bedside: A tutorial on research considerations and clinical applications.</a> Journal of Parenteral and Enteral Nutrition. 39 (7), 787-822 (2015).</li><li>Piccoli, A., Pastori, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=BIVA+software.">BIVA software.</a> Department of Medical and Surgical Sciences. , (2002).</li><li>Basso, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluid+management+in+the+intensive+care+unit:+bioelectrical+impedance+vector+analysis+as+a+tool+to+assess+hydration+status+and+optimal+fluid.">Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid.</a> Blood Purification. 36 (3-4), 192-199 (2013).</li><li>Piccoli, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+measurement+for+fluid+status+assessment.">Bioelectrical impedance measurement for fluid status assessment.</a> Contributions to Nephrology. 164, 143-152 (2010).</li><li>National Institutes of Health Technology. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+analysis+in+body+composition+measurement:+National+Institutes+of+Health+Technology+Assessment+Conference+Statement.">Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement.</a> The American Journal of Clinical Nutrition. 64, 524-532 (1996).</li><li>Silva, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lack+of+agreement+of+in+vivo+raw+bioimpedance+measurements+obtained+from+two+single+and+multifrequency+bioelectrical+impedance+devices.">Lack of agreement of in vivo raw bioimpedance measurements obtained from two single and multifrequency bioelectrical impedance devices.</a> European Journal of Clinical Nutrition. 73 (7), 1077-1083 (2019).</li><li>Mulasi, U., Kuchnia, A. J., Cole, A. J., Earthman, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioimpedance+at+the+bedside:+current+applications,+limitations,+and+opportunities.">Bioimpedance at the bedside: current applications, limitations, and opportunities.</a> Nutrition in Clinical Practice. 30 (2), 180-193 (2015).</li><li>Chabin, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioimpedance+analysis+is+safe+in+patients+with+implanted+cardiac+electronic+devices.">Bioimpedance analysis is safe in patients with implanted cardiac electronic devices.</a> Clinical Nutrition. 38 (2), 806-811 (2019).</li><li>Gonz&#225;lez-Correa, C. H., Caicedo-Eraso, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+analysis+(BIA):+a+proposal+for+standardization+of+the+classical+method+in+adults.">Bioelectrical impedance analysis (BIA): a proposal for standardization of the classical method in adults.</a> Journal of Physics: Conference Series. 47, 407 (2012).</li><li>Di Somma, S., Gori, C. S., Grandi, T., Risicato, M. G., Salvatori, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluid+assessment+and+management+in+the+emergency+department.">Fluid assessment and management in the emergency department.</a> Contributions to Nephrology. 164, 227-236 (2010).</li><li>Kammar-Garc&#237;a, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mortality+in+adult+patients+with+fluid+overload+evaluated+by+BIVA+upon+admission+to+the+emergency+department.">Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department.</a> Postgraduate Medical Journal. 94 (1113), 386-391 (2018).</li></ol>

It is important to mention that different bioelectrical impedance analysis (BIA) approaches have been proposed in the published literature, including the use of multiple frequencies at 1-500 kHz (MF-BIA), phase-sensitive single frequency (SF-BIA) at 50 kHz, and spectroscopic BIA at 5 kHz to 2 MHz. Studies have provided inconsistent results, concerning the agreement regarding single- and multiple-frequency BIA equipment6, including source current, frequency, total impedance range over which the cur...

Fluid overload (FO), defined as an excess of total body fluid or a relative excess in one or more fluid compartments1, is frequently observed in critically ill patients and is associated with higher morbidity and mortality1,2,3. The range of alterations in hydration status is wide; can indicate renal, cardiac, or hepatic failure; and/or maybe the result of excessive oral intake or iatrogenic error4. Routine assessment of hydration status is challenging in emergency departments, as the gold standard of radioisotopic volume measurement requires specialized techniques, is costly and time-consuming, and may fail to identify early disturbances in hydration status. Hence, other less-accurate methods are generally used, including clinical examination and accumulated fluid balance (volume in mL in 24 h)5. Accurate and sensitive determination of fluid volume status is necessary to help clinicians in controlling body fluids, managing intravenous fluid administration, and maintaining hemodynamic stability, thus allowing patients to receive early treatment3,5,6. Errors in the volume assessment can lead to a lack of necessary treatment or to implementation of unnecessary therapy, such as excess fluid administration, both of which are related to increased hospitalization costs, complications, and mortality4.
Interest has recently increased in bioelectrical impedance analysis (BIA), which has been considered an alternative method for the classification of an individual&#39;s hydration status. BIA is a safe, non-invasive, portable, quick, bed-side, and easy-to-use method, designed for the estimation of body compartment composition. The analysis measures the opposition generated by soft tissues to the flow of an injected alternating electric current into the body (800 &#181;A), through four surface electrodes placed on the hands and feet. Total body water estimated by BIA has been shown to have a high correlation with that obtained by deuterium dilution (r = 0.93, p = 0.01)7.
Phase-sensitive BIA devices evaluate the direct measurement of phase angle and impedance (Z50), obtaining the resistance (R) and reactance (Xc) in single-frequency mode (50 kHz) or multi-frequency mode (5 kHz to 200 kHz)8. Dividing the R and Xc values by the subject&#39;s height (in m) squared-to control for inter-individual differences in conductor length-and plotting them in an R-Xc graph is the method used in bioelectrical impedance vector analysis (BIVA) to estimate the fluid status. BIVA is an alternative impedance approach, developed by Piccoli et al.9, which uses the spatial relationship between R (i.e., the opposition to the flow of an alternating current through intra- and extra-cellular ionic solutions) and Xc to assess soft tissue hydration, independent of the multiple-regression prediction equations generated in limited and specific samples10. Therefore, the classification of fluid status is more precise and accurate than the quantification of total body water. The R and Xc values of a subject produce a vector whose position can be evaluated relative to tolerance intervals in the R-Xc graph, which can be interpreted as indicating normal or abnormal hydration, based on the distance from the mean vector derived from a healthy reference population11,12,13.
In a previous study, we compared different bioelectrical impedance analysis parameters for the detection of fluid overload and prediction of mortality in patients admitted to an emergency department (ED) and demonstrated that BIVA (relative risk = 6.4; 95% confidence interval from 1.5 to 27.9; p = 0.01) and impedance ratio (relative risk = 2.7; 95% confidence interval from 1.1 to 7.1; p = 0.04) improved the estimation of the probability of 30-day mortality3.
Fluid overload can also be estimated using the impedance ratio (imp-R), which is the ratio between impedance measured at 200 kHz and impedance measured at 5 kHz obtained by the multi-frequency bioelectrical impedance equipment. Imp-R considers conduction in total body water (Z200) and in extracellular water fluid spaces (Z5). The penetration of a current into cells is frequency-dependent and, the 200/5 kHz ratio describes the ratio of greater to lesser current entry into cells3,8. If the difference between these two values decreases over time, it may indicate that the cells are becoming less healthy14.
Imp-R values &#8804;0.78 in males and &#8804;0.82 in females have been observed in healthy individuals15. Values nearer to 1.0 indicate that the two impedances are closer to each other, and the body cell is less healthy. In the case of critical illness, the resistance of the cell membrane at 5 kHz is reduced, and the difference between the impedance values at 5 and 200 kHz is markedly lower, indicating cellular worsening3. Values &#62; 1.0 suggest device error16,17. Thus, the objective of the present study is to demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis, as well as by using the impedance ratio, measured with tetrapolar multi-frequency equipment in patients admitted to the emergency department.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Alcohol 70% swabs</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>BIVA software 2002</td>
			<td>NA</td>
			<td>NA</td>
			<td>Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in &#34;LE FORMULE DEL Prof. Piccoli&#34; section</td>
		</tr>
		<tr>
			<td>Chlorhexidine Wipes</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Examination table</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Leadwires square socket</td>
			<td>BodyStat</td>
			<td>SQ-WIRES</td>
			<td></td>
		</tr>
		<tr>
			<td>Long Bodystat 0525 electrodes</td>
			<td>BodyStat</td>
			<td>BS-EL4000</td>
			<td></td>
		</tr>
		<tr>
			<td>Quadscan 4000 equipment</td>
			<td>BodyStat</td>
			<td>BS-4000</td>
			<td>Impedance measuring range: 20 - 1300 &#937; ohms 
			Test Current: 620 &#956;A 
			Frequency: 5, 50, 100, 200 kHz 
			Accuracy: Impedance 5 kHz: +/- 2 &#937; 
			Impedance 50 kHz: +/- 2 &#937; 
			Impedance 100 kHz: +/- 3 &#937; 
			Impedance 200 kHz: +/- 3 &#937; 
			Resistance 50 kHz: +/- 2 &#937; 
			Reactance 50 kHz: +/- 1 &#937; 
			Phase Angle 50 kHz: +/- 0.2&#176; 
			Calibration: A resistor is supplied for independent verification from time to time. The impedance value should read between 496 and 503 &#937;.</td>
		</tr>
	</tbody>
</table>

evaluation of fluid overload by bioelectrical impedance vectorial analysis

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in decreased or increased mortality rates. Accurate fluid status assessment entails appropriate therapy. Unfortunately, as the gold standard method of radioisotopic fluid measurement is costly, time-consuming, and lacks sensitivity in the acute care clinical setting, other less-accurate methods are typically used, such as clinical examination or 24 h output. Bioelectrical impedance vectorial analysis (BIVA) is an alternative impedance-based approach, where the raw parameter resistance and reactance of a subject are plotted to produce a vector, the position of which can be evaluated relative to tolerance intervals in an R-Xc graph. The fluid status is then interpreted as normal or abnormal, based on the distance from the mean vector derived from a healthy reference population. The objective of the present study is to demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis and the impedance ratio measured with tetrapolar multi-frequency equipment in patients admitted to the emergency department.

As an example of the method presented above, we present the results for two women admitted to the emergency department. Bioelectrical impedance analysis was assessed at admission using a phase-sensitive multi-frequency device (see Table of Materials), and the obtained resistance (R) and reactance (Xc) values were used to calculate the BIVA graph. The results show that patients with overhydration had worse prognoses and clinical characteristics such as SOFA and Charlson index scores, which are related to ...

Watch this Scientific Journal Video about Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis at JoVE.com

Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis

In this study, we demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis (BIVA) and the impedance ratio measured using tetrapolar multi-frequency equipment in patients admitted to the emergency department. BIVA and impedance ratio are reliable and useful tools to predict poor outcomes.

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in ...

Early and accurate detection of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in decrease or increase mortality rates. The bioelectrical impedance vector analysis is an alternative impedance approach and a method used to estimate fluid status, independent of multiple regression prediction equations generated in limited and specific samples. The determination of fluid volume status is necessary to help clinicians in controlling body fluids, management intravenous fluid administration, and maintaining hemodynamic stability, thus allowing patients to receive early treatment.This method applies to all chronic patients with fluid overload, such as heart, renal, or hepatic failure. Demonstrating the procedure will be Yunuen Reyes Paz, a postgraduate student from my laboratory. To begin, clean the equipment using a chlorhexidine wipe, and then wash your hands.If the screen of the equipment shows the legend change the battery, then replace the battery. If the patient is conscious, explain the procedure to them. Obtain the age and accurate measurement of the patient's height in centimeters and introduce these data into the equipment.Remove the shoe and sock from the right foot, as well as any metal objects such as watch or bracelets worn by the patient. Place the patient in a supine position for five minutes with legs and arms spread out at a 45 degree angle before taking the measurements, verifying they're not in contact with any other part of their body. Clean the surfaces where the electrodes will be placed with a 70%alcohol pad twice.Draw an imaginary line, straight between the protruding bones on the wrist, and place two electrodes on the right hand dorsally, with each electrode in the center of that line. Place two electrodes on the right foot, one behind the third metatarsal phalangeal joint and the tarsal joint on the ankle, between the medial and lateral malleoli. To place the electrodes, follow the bones underneath.Connect the lead wires to the equipment with the red alligator clip nearest to the nails and the black clip nearest to the ankle or wrist. Ensure that the wires do not cross between them. Ensure that the patient is not talking or moving during the measurements, as this will affect the results.The patient's ID will come up on the screen. Scroll through and change the patient's parameters as described in the text manuscript. Ensure that the electrodes are stuck down correctly and press Enter.The window will indicate measuring on the screen. It takes about six to 10 seconds to measure and a beep will then sound when the measurement is complete. The equipment will display the raw impedance value at four different frequencies.Five, 50, 100 and 200 kilohertz, as well as the resistance and reactance at 50 kilohertz which are the values needed to classify a patient with fluid overload. Download the software named BIVA Tolerance RXc Graph and open it. Observe that the software is in a workbook in a spreadsheet program with seven worksheets.Guide, Reference populations, Point graph, Path, Subjects, Z-score, and Z-graph. Right-click on the Reference population sheet. Choose the line of the selected reference population and copy-paste it into the second row.Right-click on the Subjects sheet, and in the second row, insert the subject ID assigned to the patient. In the second column named Seq, always put the number one, and optionally fill out the surname and name columns. In the sex column, enter F for female and M for male patients.In the next two columns, input resistance and reactance at 50 kilohertz each. In the next two columns, insert the height in centimeters and weight in kilograms. In the population code column, insert the number that appears in the first column of the Reference population sheet.In group code, randomly choose a number between one and 10 and insert the patient's age in the next column. In the spreadsheet program menu, go to the complements tab, and right-click on the calculate option to obtain the values of resistance and reactance adjusted by height and phase angle. Right-click on the Point graph sheet and observe that 50, 75 and 95%tolerance ellipses are drawn for the selected reference population.In the dialogue box, select groups. Right-click on the number placed in the group code located on the subject's sheet, and right-click on OK.Next, the BIVA graph will appear and the subject vector as a geometric figure. Patients with vectors that fall outside the lower pole of the 75%tolerance ellipse will be classified as fluid overload.Divide Z at 200 kilohertz by Z at five kilohertz, which reflects the total body water and extracellular water compartment, respectively. To obtain the impedance ratio, a value equal to or greater than 0.85 indicates fluid overload. The plot indicated with a triangle symbol denotes a 77 year old female with normal fluid status.The bioimpedance results showed a resistance of 586.7 and reactance of 62.1. Meanwhile, the square symbol denotes a 62 year old female with fluid overload. The bioimpedance results showed resistance of 332.6 and reactance of 33.6.The patient must be in a supine position without any metallic contact. The extremity should be abducted to a body skin contact and surfaces where the electrodes are placed, with an alcohol pad should be thoroughly cleaned. The bioelectrical vector analysis and impedance ratio have proved to be useful tools in detecting the presence of fluid overload and have also shown to predict mortality risk.

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Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model

Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model  

Right ventricular (RV) volume overload (VO) is common in children with congenital heart disease. In view of distinct developmental stages,the RV ...

Predicting Prognosis in Acute Heart Failure Using Phase Angle & BIVA Z-Scores

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis 

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...

Developing an Exercise Program for Rheumatoid Arthritis Patients

Evaluation of Changes in Hydration and Body Cell Mass with Bioelectrical Impedance Analysis after Exercise Program for Rheumatoid Arthritis Patients

Author Spotlight: Implementation of BIVA for Analyzing Disease Risk Factors in Patients with Low Body Cell Mass 

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown ...

Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial ...