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EDEMA ANALYSIS

Conditions and cases

Patients admitted into intensive care units with organ failure suffer from extensive water retention due to low-functioning kidneys.

Edema is swelling caused by excess fluid trapped in body tissues. It can be associated with more serious underlying medical conditions, such as diabetes, heart failure, and kidney disease. Early detection can save lives. 

Edema needs to be monitored to ensure doctor-directed treatment is working. 

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Dropsy and edema

 

Typical Challenges

The most common method to assess edema treatment efficiency is by weighing a patient who is in a hospital bed. This approach is dated, inaccurate, unreliable, and expensive as it requires specialized hospital beds that can be weighed with the patient.

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What is edema?

Edema is swelling caused by excess fluid collecting in the body’s tissues. Although edema can become a problem with any part of the body, it is most often visible in the ankles, feet, legs, arms, and hands.

 

The signs of edema include the following:

  • Puffiness or swelling of the tissues directly under the skin, especially in the legs or arms.

  • Stretched or shiny skin.

  • Skin that does not bounce back to normal after being pressed.

  • Increased abdominal size.

  • Important note: Difficulty breathing and chest pain, along with swelling, can be signs of pulmonary edema, which requires immediate treatment.

Why does it happen?

Edema can be a result of medication or pregnancy but in hospital care it is often because of an underlying disease — often congestive heart failure, kidney disease, or cirrhosis of the liver. The underlying diseases need medical treatment along with the edema.

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How is it measured currently?

Diagnosis: If someone walks into a doctor’s office with edema, the goal is to understand what is causing edema. In cases that need further investigation, X-rays, ultrasound exams, magnetic resonance imaging, blood tests or urine analysis may be necessary. 

 

Treatment: Taking medication to remove excess fluid and reducing salt intake often relieves edema. Elevation of feet or arms can cause localized edema to dissipate. If edema is, in fact, a sign of an underlying disease, the disease requires separate treatment.

Severe edema may be treated with drugs that help expel excess fluid in the form of urine (diuretics).

Fluid overload assessment: Fluid overload assessment in critically ill patients requires accurate documentation of fluid intakes and outputs. However, there is a wide variety in how this information is recorded and reviewed.

Measuring the patient’s daily fluid balance: difference in intakes and outputs measured daily.

Measuring the patient’s cumulative fluid balance: this process takes the sum of a day’s fluid and notes balance over a period of time.

Measuring the percentage of fluid overload as adjusted for body weight: cumulative fluid balance as a percent. A ≥10 % increase is associated with increased mortality.

Measuring the patient’s fluid status: The accurate measurement of volume status is essential for continued therapy. Inadequate assessment can result in not providing the best treatment. Both too much fluid and prolonged treatment when not necessary are associated with increased mortality rates. There are several methods to evaluate a patient’s fluid status. However, it is widely recognized that most current tests are fairly inaccurate. These tests can include the following:
 

  • History and physical examination

  • Thoracic ultrasound

  • Vena cava diameter ultrasound

  • Natriuretic peptides

  • Chest radiography

How can bioelectric impedance be used to identify and measure edemas?

Bioelectrical impedance estimates body composition by detecting soft tissue hydration (only a 2–3% measurement error). Bioelectric impedance is a noninvasive, inexpensive, and highly versatile test that transforms electrical properties of tissues into clinical information. Bioimpedance vector analysis (BIVA) is used to measure fluid volume in the whole body. Patterns of vector distribution are given clinical value when compared to the healthy population (the same race, body mass index, sex, and age).

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Why is edema analysis and measurement important?

Clinical studies have shown a significant relationship between fluid overload and adverse outcomes. Management of fluid balance is a central component of managing critically ill patients.

Why is it an indicator of organ failure?

If not managed carefully, edema often results in heart or kidney failure. Several diseases and/or conditions can cause edema:
 

  • Congestive heart failure

  • Cirrhosis

  • Kidney disease or damage

  • Lymphatic system problems

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How is edema analysis used to assess the efficacy of treatment?

In critically ill patients, numerous studies show a strong relationship between fluid overload and patient mortality. Fluid overload assessment requires careful documentation, yet there is a large variance in how it is evaluated and reviewed. Determining an accurate volume status is essential for therapy. Errors of evaluation can result in either in lack of essential treatment or unnecessary fluid administration. Both are associated with increased mortality rates. Several methods of evaluation are used to determine fluid status; however, most tests currently used are inaccurate. Bioelectric impedance is the future of testing edema.

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