Skip to main content
Log in

Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring

  • Technical Note
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript



Intra-abdominal pressure (IAP) measurement techniques vary in automaticity and reproducibility. This study evaluated the intra- and interobserver variability of two new IAP measurement techniques.


A one-half open, 30-l container was used with two IAP catheters (Foley Manometer, balloon-tipped catheter) contained in a 100-ml infusion bag. To simulate intra-abdominal hypertension the container was filled with water using 5-cm increments (0–25 cmH2O). Pressure was determined by observers using the Foley Manometer and simultaneously recorded using an IAP monitor. Observers were blinded to the reference levels.


Fifteen observers conducted three pressure readings at each of the six pressure levels with the Foley technique, giving 270 readings. These were paired with the automated monitor readings and the height of the water column. The intra- and interobserver coefficients of variation were low for both methods. The Spearman correlation coefficient was higher than 0.9 for all paired measurements and Bland-Altman analysis comparing the reference H2O column to both measurement techniques showed a very good agreement at all pressure intervals (bias 0.1±0.6 cmH2O) and a consistent, low underestimation of the reference water column pressure by both techniques.


Both the Foley Manometer and the IAP monitor are reliable and reproducible methods to measure IAP in this in vitro model. The coefficient of variation for each technique is low and decreases with increasing IAP, the monitor giving more reproducible results than the Foley Manometer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1 A
Fig. 2 A

Similar content being viewed by others


  1. Malbrain ML (2004) Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 10:132–145

    Google Scholar 

  2. Quintel M, Pelosi P, Caironi P, Meinhardt JP, Lücke T, Herrmann P, Taccone P, Rylander C, Valenza F, Carlesso E, Gattinoni L (2004) An increase of abdominal pressure increases pulmonary edema in oleic acid induced lung injury. Am J Respir Crit Care Med 169:534–541

    Article  PubMed  Google Scholar 

  3. Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, Valdivia A, Ware DN, Moore FA (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54:848–859

    PubMed  Google Scholar 

  4. Richardson JD Trinkle JK (1976) Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 20:401–404

    Article  CAS  PubMed  Google Scholar 

  5. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829

    Article  PubMed  Google Scholar 

  6. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33:279–282

    CAS  PubMed  Google Scholar 

  7. Malbrain ML (1999) Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 25:1453–1458

    Article  CAS  PubMed  Google Scholar 

  8. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF (2000) Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 49:621–626

    Google Scholar 

  9. Malbrain ML (2004) Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 30:357–371

    Article  Google Scholar 

  10. Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26:1428–1431

    Google Scholar 

  11. Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR (2000) Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 43:207–211

    Google Scholar 

  12. Cheatham ML Safcsak K (1998) Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 186:594–595

    Google Scholar 

  13. Malbrain M (2004) The assumed problem of air bubbles in the tubing during intra-abdominal pressure measurement. Reply to Dr. De waele. Intensive Care Med 30:1693

    Google Scholar 

  14. Schachtrupp A, Tons C, Fackeldey V, Hoer J, Reinges M, Schumpelick V (2003) Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model. Intensive Care Med 29:1605–1608

    Google Scholar 

  15. De Potter T, Dits H, Deeren D, Libeer C, Malbrain MLNG (2004) Inter and intra-observer variability during intermittent and continuous intraabdominal pressure monitoring. WCACS abstract book, A72

  16. Balogh Z, Jones F, D’Amours S, Parr M, Sugrue M (2004) Continuous intra-abdominal pressure measurement technique. Am J Surg 188:679–684

    Google Scholar 

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I:307–310

    Google Scholar 

  18. Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180:745–753

    Google Scholar 

  19. Ivatury RR, Diebel L, Porter JM, Simon RJ (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77:783–800

    Google Scholar 

  20. Collee GG, Lomax DM, Ferguson C, Hanson GC (1993) Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med 19:478–480

    Google Scholar 

  21. Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W, Allen JE, Jewett TC Jr, Karp MP, Cooney DR (1987) The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg 22:1207–1211

    Google Scholar 

  22. Obeid F, Saba A, Fath J, Guslits B, Chung R, Sorensen V, Buck J, Horst M (1995) Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg 130:544–547

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Manu L. N. G. Malbrain.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Potter, T.J.R., Dits, H. & Malbrain, M.L.N.G. Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. Intensive Care Med 31, 747–751 (2005).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: