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Model-based correction of the influence of body position on continuous segmental and hand-to-foot bioimpedance measurements

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Abstract

Bioimpedance spectroscopy (BIS) is suitable for continuous monitoring of body water content. The combination of body posture and time is a well-known source of error, which limits the accuracy and therapeutic validity of BIS measurements. This study evaluates a model-based correction as a possible solution. For this purpose, an 11-cylinder model representing body impedance distribution is used. Each cylinder contains a nonlinear two-pool model to describe fluid redistribution due to changing body position and its influence on segmental and hand-to-foot (HF) bioimpedance measurements. A model-based correction of segmental (thigh) and HF measurements (Xitron Hydra 4200) in nine healthy human subjects (following a sequence of 7 min supine, 20 min standing, 40 min supine) has been evaluated. The model-based compensation algorithm represents a compromise between accuracy and simplicity, and reduces the influence of changes in body position on the measured extracellular resistance and extracellular fluid by up to 75 and 70%, respectively.

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Abbreviations

α:

Heuristic parameter (Cole–Cole model)

c :

Circumference

C PRO :

Protein concentration

C PRO,P :

Protein concentration in plasma

C PRO,IntF :

Protein concentration in interstitial fluid

D B :

Body density

D Muscle :

Density of muscle

IntFRel :

Relative amount of interstitial fluid

K f :

Filtration coefficient

K ECF,Muscle :

Amount of interstitial fluid per muscle mass

P C :

Capillary hydrostatic pressure

ΠC :

Capillary oncotic pressure

P IntF :

Interstitial hydrostatic pressure

ΠIntF :

Interstitial oncotic pressure

Q L,S :

Nominal lymphatic flow for a segment

Q Lymph,S :

Effective lymphatic flow for a segment

Q Rel,S :

Relative lymphatic flow

Q PI,S :

Fluid shift ratio from capillary to interstitial space

ρECF :

Specific resistivity of extracellular fluid

RV/RA:

Postcapillary to precapillary resistance ratio

R e :

Extracellular resistance

R i :

Intracellular resistance

T D :

Time delay

S:

Segment

V S :

Segmental volume

V B :

Body volume

BIS:

Bioimpedance spectroscopy

ECF:

Extracellular fluid

HF:

Hand-to-foot

ICF:

Intracellular fluid

IntF:

Interstitial fluid

PV:

Plasma volume

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Acknowledgments

Special thanks go to Dr. Chamney, Dr. Wabel, and Dr. Moissl at Fresenius Medical Care GmbH for their help with the literature and for interesting discussions. This work was partially supported by the Science and Technology National Board of the Mexican government (CONACYT).

Author information

Authors and Affiliations

  1. Philips Chair for Medical Information Technology (MedIT), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, 52074, Aachen, Germany

    Guillermo Medrano, Marian Walter & Steffen Leonhardt

  2. Department of Nephrology (Medical Clinic II), University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany

    Frank Eitner

Authors
  1. Guillermo Medrano
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Corresponding author

Correspondence to Guillermo Medrano.

Appendix

Appendix

1.1 Calculation of P IntF for the torso

Fluid shifts from the legs to the torso for the change of vertical to supine position, and vice versa, as observed through bioimpedance [9, 35, 41] and computer tomography [2] measurements. Accordingly, fluid in the torso should flow from the capillaries into the interstitium during supine position and in the opposite direction during standing position. Values reported for the chest (lungs capillaries) [13] were taken to capture the effect of Starling’s forces in the torso, resulting in the right direction during supine (Fig. 6a, left), but in the opposite direction during standing position (Fig. 6a, right).

Fig. 6
figure 6

Starling’s forces in the torso (in mmHg, signs have been represented as directions) and expected and produced direction of the fluid shift between interstitial and capillary spaces for supine and standing position. a ΠC, ΠIntF, and P IntF according to [13]. P C as explained in the Sect. 2.6.1. b P IntF according to analysis (see text)

Full size image

To satisfy the desired result during standing position, the following relation must be fulfilled:

$$ {P_{\text{C}} + P_{\text{IntF}} + \Uppi_{\text{IntF}} < \Uppi_{\text{C}} } $$
(22)

Equation 22 indicates that during a change from supine to standing position, a fast change in one of the pressures (in addition to the change already considered in P C) is necessary. As a fast change in ΠIntF and ΠC is not expected [16, 30] the values for P C, ΠIntF, and ΠC for the standing position can be substituted on Eq.  22:

$$ {12 + P_{\text{IntF}} + 14 < 28\;({\text{mmHg)}}} $$
(23)
$$ {P_{\text{IntF}} < 2\;({\text{mmHg}})} $$
(24)

Considering the directions of the arrows, a value of |P IntF| = 1 mmHg (physiologically −1 mmHg) during standing position was assumed. The result can be seen in Fig. 6b. Explanations for this value could be: (a) the influence of gravity in the pleura (standing position should lead to a reduction of |P IntF|) [31] or (b) an increase in the intraperitoneal pressure in the lower part of the abdomen [8], producing a reduction of |P IntF|.

1.1.1 Sensitivity analysis

The influence of model parameter values on ΔR e has been determined through simulations using nominal parameter values +10%. Anthropometric changes influenced only the initial R e value. Changes in the amount of proteins (C Pro,P) and in fluid volume state (IntF (P IntF)) present a relatively large influence on the simulated ΔR e (see details in Table 3).

Table 3 Influence of using initialisation values +10% on the simulated ΔR e (%) and R e (%)
Full size table

Suitability of the influence of different C Pro,P and IntF (P IntF) values on ΔR e:

  • As healthy C Pro,P can range from 6.5 to 7.2 g/dl (reference [38]) or even between 6.4 and 8.3 g/dl (reference [12]), which is more than +10%, this parameter may influence the differences between simulations and measurements.

  • Since a mild dehydration constitutes a loss of 3% of body weight and about 20% of ECF without presenting any clear symptoms [39], a local change of IntF by 10% is very possible and the local PIntF for each subject could vary from the assumed initial PIntF = −3 mmHg.

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Medrano, G., Eitner, F., Walter, M. et al. Model-based correction of the influence of body position on continuous segmental and hand-to-foot bioimpedance measurements. Med Biol Eng Comput 48, 531–541 (2010). https://doi.org/10.1007/s11517-010-0602-5

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