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Feasibility of bioimpedance spectroscopy and long-term functional assessment in critically ill children
Lori J Bechard1, Carrie P Earthman2, Bethany Farr1
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Insights
This study shows that bioimpedance spectroscopy (BIS) is feasible for assessing body composition in critically ill children. Functional status improved significantly, but quality of life measures did not change within six months post-PICU discharge.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Body composition analysis
Background:
- Lean body mass loss in critically ill children impacts long-term functional status and quality of life.
- Assessing body composition in the pediatric intensive care unit (PICU) is crucial for understanding these impacts.
Purpose of the Study:
- To determine the feasibility of using bioimpedance spectroscopy (BIS) for body composition assessment in mechanically ventilated, critically ill children.
- To evaluate functional status and quality of life up to 6 months post-PICU admission.
Main Methods:
- A prospective, observational pilot study was conducted in a multidisciplinary PICU.
- Included were children aged 1 month to 18 years requiring mechanical ventilation for at least 5 days.
- Feasibility of assessments using BIS, Functional Status Scale (FSS), and Pediatric Quality of Life (Peds QL) was examined.
Main Results:
- Feasible bedside BIS measurements and remote functional/quality of life assessments were demonstrated.
- BIS variables (phase angle, impedance ratio) correlated with FSS at PICU discharge.
- Significant improvement in FSS scores (total and tech domains) was observed from enrollment to 6 months post-discharge.
Conclusions:
- Bedside BIS measurements are feasible in the PICU setting.
- Functional status significantly improved in critically ill children post-discharge.
- Body composition and long-term outcomes should be integrated into nutrition trials for critically ill children.
Background & Aims:
Lean body mass loss due to critical illness in childhood could be detrimental to long term outcomes, including functional status and quality of life. We describe the feasibility of body composition assessment by bioimpedance spectroscopy (BIS) in the pediatric intensive care unit (PICU), and functional status and quality of life assessments up to 6 months following admission in a cohort of mechanically ventilated, critically ill children.
Methods:
We conducted a prospective, observational pilot study in a multidisciplinary PICU. Children aged 1 month to 18 years who required mechanical ventilation, with expected stay in the PICU of at least 5 days were included. We examined the feasibility of consenting, enrolling, and completing baseline and 6-month assessments of BIS variables, Functional Status Scale (FSS), and Pediatric Quality of Life (Peds QL), in eligible patients.
Results:
Of 32 patients approached, 23 (72%) completed baseline assessments [median (IQR) age 3.4 (1.0, 7.8) years, 14 (61%) male]; 6-month assessments were completed in 15 (65%) enrolled patients. Mean (SD) phase angle at study enrollment was 2.95 (0.93) and the impedance ratio was 0.90 (0.03). Phase angle (rs = -0.58, p = 0.03) and impedance ratio (rs = 0.61, p = 0.02) by BIS were significantly correlated with total FSS at PICU discharge. Median total FSS and FSS tech (feeding and respiratory domains of FSS) scores improved from enrollment [16 (13, 26) and 8 (7, 10)] to 6 months [6 (6, 9) and 2 (2, 4), respectively, p < 0.001]. Median Peds QL total, physical summary and psychosocial summary scores were not significantly different between PICU discharge and 6 months after PICU admission. Correlations between the total 6-month FSS and a) phase angle (-0.45, p = 0.197) and b) impedance ratio (0.56, p = 0.096) at PICU discharge were not significant.
Conclusions:
We have demonstrated the feasibility of obtaining bedside BIS measurements in the PICU, and functional and quality of life assessments remotely following PICU discharge. Body composition and long-term assessment of functional outcomes and quality of life must be incorporated in nutrition trials in critically ill children.
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