Author(s) Linda L. Chlan^*

Affiliation(s)
Symptom Management College of Nursing, The Ohio State University, Newton Hall, Columbus, USA.

ABSTRACT

Background: Critically ill patients receiving prolonged mechanical ventilatory support are at risk for loss of muscle mass and muscle strength from immobility. Feasible, non-invasive methods are needed to accurately obtain data on markers of muscle mass to design effective interventions and monitor patient progress during recovery from critical illness. Bioelectric impedance has been used in other settings to obtain data on body composition and muscle mass. Purpose: The aims of this study were to determine the feasibility of bioelectric impedance as a marker of muscle mass in a sample of mechanically ventilated patients and to assess data trends in these obtained values. Methods: A descriptive design was used to obtain standard bioelectric impedance parameters (total body resistance, legs resistance, and percent lean body mass) over 4 days from eligible patients already enrolled in a randomized clinical trial. Results: Bioimpedance parameters were readily obtained over 4 days in a sample of 43 patients (age 59 + 15.7 years, 56% male) receiving prolonged ventilatory support (mean 9.4 + 10.4 days) due to respiratory failure. Reasons for not obtaining impedance measures included skin impairment, monitoring devices, or presence of implantable cardiac defibrillator or pacemaker. Average total body impedance was 464.3 + 117.1 ohms, while average impedance of legs was 479.1 + 146.4 ohms. Lean body mass was 68.4% (+10.8). Conclusions/Implications for Practice: With carefully trained staff and a standardized measurement protocol, bioimpedance is a feasible method to obtain body composition data reflective of muscle mass in mechanically ventilated patients. Further research will determine the utility of bioimpedance to monitor recovery and effectiveness of interventions to restore function after prolonged periods of ventilatory support and immobility in mechanically ventilated patients.

KEYWORDS
Mechanical Ventilation; Bioimpedance; Muscle Mass; ICU-Acquired Weakness

Cite this paper
Chlan, L. (2014) Feasibility of bioelectric impedance as a measure of muscle mass in mechanically ventilated ICU patients. Open Journal of Nursing, 4, 51-56. doi: 10.4236/ojn.2014.41008.

References
[1]   Cox, C., Carson, S., Govert, J., Chelluri, L. and Sanders, G. (2007) An economic evaluation of prolonged mechanical ventilation. Critical Care Medicine, 35, 1918-1927.
http://dx.doi.org/10.1097/01.CCM.0000275391.35834.10

[2]   Schweikert, W. and Hall, J. (2007) ICU-acquired weakness. CHEST, 131, 1541-1549.
http://dx.doi.org/10.1378/chest.06-2065

[3]   Chelluri, L., Im, K. and Belle, S. (2004) Long-term mortality and quality of life after prolonged mechanical ventilation. Critical Care Medicine, 32, 61-69.
http://dx.doi.org/10.1097/01.CCM.0000098029.65347.F9

[4]   De Jonghe, B., Bastuji-Garin, S. and Durand, M. (2007) Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Critical Care Medicine, 35, 2007-2015.
http://dx.doi.org/10.1097/01.ccm.0000281450.01881.d8

[5]   Jackson, J., Mitchell, N. and Hopkins, R. (2009) Cognitive functioning, mental health, and quality of life in ICU survivors: An overview. Critical Care Clinics, 25, 615-628. http://dx.doi.org/10.1016/j.ccc.2009.04.005

[6]   Taruli, A.W., Duggal, N., Esper, G.J., Garmirian, L.P., Fogerson, P.M., Lin, C.H., et al. (2009) Electrical impedance myography in the assessment of disuse atrophy. Archives of Physical Medicine and Rehabilitation, 90, 1806-1810. http://dx.doi.org/10.1016/j.apmr.2009.04.007

[7]   Fan, E., Zanni, J., Dennison, C., Lepre, S. and Needham D. (2009) Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Advanced Critical Care, 20, 243-253.
http://dx.doi.org/10.1097/NCI.0b013e3181ac2551

[8]   Ali, N., O’Brien, J. and Hoffman, S. (2008) Acquired weakness, handgrip strengths, and mortality in critically ill patients. American Journal of Respiratory and Critical Care Medicine, 178, 261-268.
http://dx.doi.org/10.1164/rccm.200712-1829OC

[9]   Hodgin, K., Nordon-Craft, A., McFann, K., Mealer, M. and Moss, M. (2009) Physical therapy utilization in intensive care units: Results from a national survey. Critical Care Medicine, 37, 561-568.
http://dx.doi.org/10.1097/CCM.0b013e3181957449

[10]   Schweikert, W., Pohlman, M., Pohlman, A. and Kress, J.P. (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet, 373, 1874-1882.
http://dx.doi.org/10.1016/S0140-6736(09)60658-9

[11]   Rutkove, S.B. (2009) Electrical impedance myography: Background, current state, and future directions. Muscle and Nerve, 40, 936-946.
http://dx.doi.org/10.1002/mus.21362

[12]   Biodynamics Corporation. (2004-2009) Quick start guide for the BIA 450. www.biodyncorp.com

[13]   Lukaski, H.C. and Bolunchuk, W.W. (1988) Estimation of body fluid volumes using tetrapolar bioelectrical impedance measurements. Aviation, Space and Environmental Medicine, 59, 1163-1169.

[14]   Lukaski, H., Johnson, P., Bolunchuk, W.W. and Lykken, G. (1985) Assessment of fat free mass using bioelectrical measurements of the human body. American Journal of Clinical Nutrition, 41, 810-817.

[15]   Mattsson, S. and Thomas, B. (2006) Development of methods for body composition studies. Physical Medicine and Biology, 51, R203-R228.
http://dx.doi.org/10.1088/0031-9155/51/13/R13

[16]   Janssen, I., Heymsfield, S. and Ross R. (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. Journal of the American Geriatrics Society, 50, 889-896. http://dx.doi.org/10.1046/j.1532-5415.2002.50216.x

[17]   Patterson, R. (2000) Bioelectric Impedance Measurements. In: Bronzio, J.D., Ed., Biomedical Engineering Handbook (Vol. 1), CRC Press and IEEE Press, 731-735.

[18]   Rutkove, S.B., Zhang, H., Schoenfeld, D.A., Raynor, E.M., Shefner, J.M., Cudkowicz, M.E., et al. (2007) Electrical impedance myography to assess outcome in amyotrophic lateral sclerosis clinical trials. Clinical Neurophysiology, 118, 2413-2418.
http://dx.doi.org/10.1016/j.clinph.2007.08.004

[19]   Arron, R. and Shiffman, C.A. (2000) Using localized impedance measurements to study muscle changes in injury and disease. Annals of the New York Academy of Sciences, 904, 171-180.
http://dx.doi.org/10.1111/j.1749-6632.2000.tb06443.x

[20]   Merriam-Webster Dictionary.
http://www.merriam-webster.com/dictionary/feasible

[21]   Chlan, L., Weinert, C., Heiderscheit, A., Tracy, M.F., Skaar, D.J., Guttormson, J. and Savik, K. (2013) Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: A randomized clinical trial. JAMA: The Journal of the American Medical Association, 309, 2335-2344.
http://dx.doi.org/10.1001/jama.2013.5670