ConsensusPaper on the use of BIVA (BioelectricalImpedanceVector Analysis) in medicine for the managment of bodyhydratation.

Hydration status assessment remains a challenge overall in sub- clinical hyper/dehydration status. Biompedance Vector Analysis (BIVA) is a non invasive technique to estimate body mass and water composition by bioelectrical impedance measurements, resistance and reactance. The BIVA method is a unique non invasive technique that allows the combined evaluation of hydration and mass of soft tissues in any clinical condition without knowledge of body weight. This tool can aid physicians to make a fast and correct assessment in facilitating the management of hydration status in critical ill patients in different medicine settings (Cardiology, Nephrology,Gastroenterology, Internal Medicine, Geriatrics and Emergency Medicine). In Nephrology BIVA contribute to the appropriate diuretic prescriptions in chronic kidney diseases and to the identification of the adequate volume of fluid removed during hemodialysis (reducing hypotension and cramp episode, preventing nocturnal pulmonary edema, ameliorating blood pressure control and maintaining an effective diuresis for long time). In heart failure patients the combined use of BIVA, biomarkers and bedside ultrasonography allows to: a faster and more accurate diagnosis, distinguish cardiogenic and non cardiogenic dyspnea, support decisions about diuretic therapy, an accurate risk stratification of patients. Ultrafiltration is increasingly recognized as a crucial area of patients with advanced heart failure and fluid overload. The key management goal is careful monitoring of fluid status with early treatment and application of a systematic approach to managing patient during UF The role of combined technology in assessing. Hydration has to be defined, but BIVA seems to be of potential value for detecting adequately changes in hydration. In critical patients arriving at ED, earlier treatment is associated with decreased mortality .BIVA represents a new technology with the potential to objectively define congestive status in ED patients with AHF Further, it may have utility in identifying patients who require volume overload reduction therapy, as well as serving as an aid to ED disposition. Future studies aimed to better elucidate the role of BIVA in the management of dehydrated patients should be performed to standardize the use of this technique in these critical patients.