Relationship between Intake and Output Balance and Body Weight Changes in Intensive Care Unit Patients

중환자의 체중변화와 섭취량과 배설량 균형과의 관계

  • Received : 2011.02.15
  • Accepted : 2011.05.06
  • Published : 2011.05.31

Abstract

Purpose: The purpose of this study was to identify differences between intake and output balance and body weight changes and to identify factors related to differences in critically ill patients. Methods: The participants for this descriptive correlational study were 65 medical surgical ICU patients. The data were collected from patient medical records. Results: Mean age of the patients was 63.80 years (${\pm}15.21$). Body weight changes for 48 hours averaged 281.54g (${\pm}2210.48$). I&O balance for 48 hours corrected for insensible loss averaged 398.1ml. Differences ranged from 45mL to 7,535mL. In the distribution of absolute difference between body weight change and intake and output balance, only 40% of the patients were within less than 1,000 mL. Factors relating to accurate measure of intake and output were ventilation methods, respiration patterns, and edema status. Conclusion: Although mean values of weight change and I&O balance for all patients were very close, the range of differences was very wide indicating that, for many patients, intake and output is not an appropriate indicator of body fluid balance. Therefore, because of the frequency fever and/or hyperventilation, nurses need to use caution when using intake and output balance only to estimate current body fluid status for critically ill patients.

Keywords

References

  1. Chung, L.H., Chong, S., & French, P. (2002). The efficiency of fluid balance charting: An evidence-based management project. Journal of Nursing Management, 10, 103-113. https://doi.org/10.1046/j.0966-0429.2001.00296.x
  2. Daffurn, K., Hillman, K., Bauman, A., Lum, M., Crispin, C., & Ince, L. (1994). Fluid balance charts: do they measure up?. British Journal of Nursing, 3(16), 816-820.
  3. Eastwood, G. (2006). Evaluating the reliability of recorded fluid balance to approximate body weight change in patients undergoing cardiac surgery. Heart & Lung, 35(1), 27-33. https://doi.org/10.1016/j.hrtlng.2005.06.001
  4. Gil, C., & Mendoza, D. (2003). Accumulated fluid balance in patients admitted to the ICU: Is it really reliable?. Enfermeria Intensiva, 14(4), 148-155. https://doi.org/10.1016/S1130-2399(03)78120-6
  5. Gross, C. R., Lindquist, R. D., Woolley, A. C., Granieri, R., Allard, K., & Webster, B. (1992). Clinical indicators of dehydration severity in elderly patients. Journal of Emergency Medicine, 10(3), 267-274. https://doi.org/10.1016/0736-4679(92)90331-M
  6. Guyton, A., & Hall, J. (2000). Textbook of medical physiology (10th ed.). Philadelphia: W. B. Saunders Co.
  7. Hoff, R. G., Dijk, G. W., Algra, A., Kalkman, G. J., & Rinkel, G. J. (2008). Fluid balance and blood volume measurement after aneurysmal subarachnoid hemorrhage. Neurocirtical Care, 8(3), 391-397. https://doi.org/10.1007/s12028-007-9043-x
  8. Kim, S. (2011). Evaluation and management of volume status: A practical view. The Korean Journal Internal Medicine, 80(10), 1-7.
  9. Meguid, M. M., Lukaski, H. C., Tripp, M. D., Rosenburg, J. M., & Parker, F. B. (1992). Rapid bedside method to assess changes in postoperative fluid status with bioelectrical impedance analysis. Surgery, 112(3), 502-508.
  10. Meiner, S. E. (2002). Fluid balance documentation: A case study of daily weight and intake/output omissions. Geriatric Nursing, 23(1), 46-47.
  11. Popowski, L., Oppliger, R., & Lambert, G. (2001). Blood and urinary measures of hydration status during progressive acute dehydration. Medicine and Science in Sports and Exercise, 33(5), 747-753.
  12. Randerath, W. J., Meier, J., Genger, H., Domanski, U., & Rühle, K. H. (2002). Efficiency of cold passover and heated humidification under continuous positive airway pressure. European Respiratory Journal, 20(1), 183-186. https://doi.org/10.1183/09031936.02.00267902
  13. Roos, A., Westendorp, R., Frolich, M., & Meinders, A. (1993). Weight changes in critically ill patients evaluated by fluid balances and impedance measurements. Critical Care Medicine, 21(6), 871-877. https://doi.org/10.1097/00003246-199306000-00015
  14. Shirreffs, S. M. (2003). Markers of hydration status. European Journal of Clinical Nutrition, 57(Suppl 2), 56-59.
  15. Suhayda, R., & Walton, J. (2002). Preventing and managing dehydration. MEDSURG Nursing, 11(6), 267-279.
  16. Sund-Levander, M., Forsberg, C., & Wahren, L. (2002). Normal oral, rectal, tympanic and axillary body temperature in adult men and women: A systematic literature review. Scandinavian Journal of Caring Science, 16, 122-128. https://doi.org/10.1046/j.1471-6712.2002.00069.x
  17. Tang, V. & Lee E. (2910). Fluid balance chart: Do we understand it?. Clinical Risk, 16, 10-13.
  18. Welch, K. (2010). Fluid balance. Learning Disability Practice. 13(6), 33-38.
  19. Wise, L., Mersch, J., Racioppi, J., Crosier, J., & Thompson, C. (2000). Evaluating the reliability and utility of cumulative intake and output. Journal of Nursing Care Quality, 14(3), 37-42. https://doi.org/10.1097/00001786-200004000-00005
  20. Yamaguchi, H., Yamauchi, H., Hazama, S., & Hamamoto, H. (2000). Evaluation of body fluid status after cardiac surgery using bioelectrical impedance analysis. The Journal of Cardiovascular Surgery, 41(4), 559-566.
  21. Yang, Y. H., Choi, S., Kim, E. K., & Sung, I. S. (1996). A study of the fluid balance of the patients on soft diets. Journal of Korean Academy Nursing, 26(3), 688-696.