Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children
Patient position and body mass index (BMI) affect intra-abdominal pressure (IAP) measured by the intra-vesical method in adults. We sought to determine effects of patient position and BMI on IAP in children because accurate measurement and interpretation of IAP are important for patient management.
Seventy-seven mechanically ventilated children (<18 years) admitted to a PICU were prospectively studied. IAP was taken with the head of the bed at 0° and 30° every 6 h over a 24-h period. Statistical methods included descriptives, univariate statistics to identify potential confounding variables and multivariable analysis to assess the impact of position on IAP after adjusting for the significant covariates.
Seventy-seven patients had 290-paired IAP measurements. Mean IAP at 30° was 10.6 ± 4.0 compared to 8.4 ± 4.0 at 0°, which was significantly higher (p = 0.026) even after adjusting for age, gender and length. There was no correlation between IAP and actual BMI or BMI percentiles.
Patient position should be considered when interpreting IAP. BMI did not influence IAP measurements in children.
KeywordsSemi-recumbent position Body mass index Intra-abdominal pressure Children Intra-vesical method
The authors would like to thank Drs. Steve Treiman and Don Moores for review of this manuscript. We would also like to thank WolfeTory Medical Inc. for partial grant support of this study, including supplying the Abviser equipment for bladder pressure measurement.
- 1.Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med 32:1722–1732CrossRefPubMedGoogle Scholar
- 2.Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Wilmer A (2007) Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment Syndrome. II. Recommendations. Intensive Care Med 33:951–962CrossRefPubMedGoogle Scholar
- 20.De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, Cresswell AB, Malbrain M, Bodnar Z, Mejia-Mantilla JH, Reis R, Parr M, Schulze R, Compano S, Cheatham M (2008) The effect of different reference transducer positions on intra-abdominal pressure measurement: a multicenter analysis. Intensive Care Med 34:1299–1303CrossRefPubMedGoogle Scholar
- 23.Ejike JC, Mathur M (2006) Patient positioning: does it affect intra-abdominal pressure measurements in children? Intensive Care Med 32(Suppl 1):1155 (abstract)Google Scholar
- 24.August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, Silverstein JH, Speiser PW, Styne DM, Montori VM (2008) Prevention and treatment of pediatric obesity: an Endocrine Society Clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 93:4576–4599CrossRefPubMedGoogle Scholar
- 25.National Center for Health Statistics, 2000 CDC Growth Charts: United States; clinical growth charts. http://www.cdc.gov/growthcharts. Accessed 16 May 2008
- 26.Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2000) 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 246:1–190Google Scholar
- 27.van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, Joore HCA, Strack van Schijndel RJM, van der Tweel I, Ramsay G, Bonten MJM (2006) Feasibility and effects of the recumbent position to prevent ventilator associated pneumonia: a randomized study. Crit Care Med 34:396–402CrossRefPubMedGoogle Scholar
- 30.Orozco-Levi M, Torres A, Ferrer M, Piera C, el-Ebiary M, de la Bellacasa JP, Rodriguez-Roisin R (1995) Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 152:1387–1390PubMedGoogle Scholar