Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal
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The diagnosis of intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS) is heavily dependant on the reproducibility of the intra-abdominal pressure (IAP) measurement technique. Recent studies have shown that a clinical estimation of IAP by abdominal girth or by examiner’s feel of the tenseness of the abdomen is far from accurate, with a sensitivity of around 40%. Consequently, the IAP needs to be measured with a more accurate, reproducible and reliable tool. The role of the intra-vesical pressure (IVP) as the gold standard for IAP has become a matter of debate. This review will focus on the previously described indirect IAP measurement techniques and will suggest new revised methods of IVP measurement less prone to error. Cost-effective manometry screening techniques will be discussed, as well as some options for the future with microchip transducers.
KeywordsIntra-abdominal pressure Intra-abdominal hypertension Abdominal compartment syndrome Intra-vesical pressure
I am indebted to my wife, Ms. Bieke Depré, for her patience, advice and technical assistance with the preparation of this manuscript, and to my three sons for providing a quiet writing environment. I also thank Dr. Rao Ivatury and Julia Wendon for their English editing of the manuscript. Part of this work was presented at: the 14th Annual Congress of the European Society of Intensive Care Medicine, Geneva, Switzerland, 30 September–3 October 2001; the 22nd International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 19–22 March 2002; the 13th Symposium Intensivmedizin and Intensivpflege, Bremen, Germany, 19–21 February 2003; the 23rd International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 18–21 March 2003; the 16th Annual Congress of the European Society of Intensive Care Medicine, Amsterdam, The Netherlands, 5–8 October 2003. This study was supported by Holtech Medical, Denmark (contact Bo Holte at firstname.lastname@example.org). There was no financial support from Holtech other than making the product (Foleymanometer) available, free of charge. This study was supported by Ackrad Medical, USA (contact Charles Noto at email@example.com). There was no financial support from Ackrad other than making five oesophageal balloon catheters available, free of charge. This study was supported by Spiegelberg, Germany (contact Andreas Spiegelberg at firstname.lastname@example.org). There was no financial support from Spiegelberg other than making the gastric balloon IAP-catheters and IAP-monitors available for study purposes, free of charge.
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