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In vitro validation of a novel methodfor continuous intra-abdominalpressure monitoring

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Intra-abdominal pressure (IAP) measurement is important in daily clinical practice. Most measurement techniques vary in automaticity and reproducibility. This study tested a new fully automated continuous technique for IAP measurement, the CiMON.


Three IAP measurement catheters (a Foley manometer and two balloon-tipped catheters) contained in a 50-ml infusion bag were placed on the bottom of a half open 3-l container. To simulate IAH the container was filled with water using 5 cmH2O increments (0–30 cmH2O). Pressure was estimated by observers using the Foley manometer (IAPFM) and simultaneously recorded using two IAP monitors: IAPspie with Spiegelberg and IAPCiM with CiMON. Observers were blinded to the reference levels. Fifteen observers (three intensivists, four residents, two medical students, and six nurses) conducted three pressure readings at each of the seven pressure levels with the FM technique, giving 315 readings. These were paired with the automated IAPspie and IAPCiM readings and the height of the H2O column.


The intra- and interobserver coefficients of variation (COVA) were low for all methods. There was no difference in the results between specialists, physicians in training, andnurses. Spearman's correlation coefficient (R 2) values for all paired measurements were greater than 0.9, and Bland–Altman analysis comparing the reference H2O column, IAPFM, and IAPspie to IAPCiM showed a very good agreement at all pressure levels (bias –0.1 ± 0.6 cmH2O, 95%CI –0.2 to 0). There was a consistent, low underestimation of the reference H2O pressure by the Spiegelberg technique and a low overestimation at pressures below 20 cmH2O by both other techniques.


All three measurement techniques, IAPFM, IAPspie, and IAPCiM have good agreement with the applied hydrostatic pressure in this in vitro model of IAP measurement.

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  1. Malbrain ML, Deeren D, De Potter TJ (2005) Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 11:156–171

    Article  PubMed  Google Scholar 

  2. Kimball EJ, Kim W, Cheatham ML, Malbrain ML (2007) Clinical awareness of intra-abdominal hypertension and abdominal compartment syndrome in 2007. Acta Clin Belg 62(Suppl):66–73

    Google Scholar 

  3. 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 

  4. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L (2005) Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322

    Article  PubMed  Google Scholar 

  5. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K (1999) Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 134:1082–1085

    Article  PubMed  CAS  Google Scholar 

  6. Biancofiore G, Bindi ML, Romanelli AM, Bisa M, Boldrini A, Consani G, Filipponi F, Mosca F (2003) Postoperative intra-abdominal pressure and renal function after liver transplantation. Arch Surg 138:703–706

    Article  PubMed  Google Scholar 

  7. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2007) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 33:951–962

    Article  PubMed  Google Scholar 

  8. De laet I, Malbrain ML (2007) ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom? Acta Clin Belg 62(Suppl):190–199

    Google Scholar 

  9. Malbrain ML, De laet I, Cheatham M (2007) Consensus conference definitions and recommendations on intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS)—the long road to the final publications, how did we get there? Acta Clin Belg 62(Suppl):44–59

    Google Scholar 

  10. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi 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 32:1722–1732

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Malbrain ML (2004) The assumed problem of air bubbles in the tubing during intra-abdominal pressure measurement—author reply. Intensive Care Med 30:1693

    Google Scholar 

  14. De Potter TJ, Dits H, Malbrain ML (2005) Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. Intensive Care Med 31:747–751

    Article  PubMed  Google Scholar 

  15. Balogh Z, De Waele JJ, Malbrain ML (2007) Continuous intra-abdominal pressure monitoring. Acta Clin Belg 62(Suppl):26–32

    Google Scholar 

  16. De Waele JJ, De laet I, Malbrain ML (2007) Rational intraabdominal pressure monitoring: how to do it? Acta Clin Belg 62(Suppl):16–25

    Google Scholar 

  17. Schachtrupp A, Henzler D, Orfao S, Schaefer W, Schwab R, Becker P, Schumpelick V (2006) Evaluation of a modified piezoresistive technique and a water-capsule technique for direct and continuous measurement of intra-abdominal pressure in a porcine model. Crit Care Med 34:745–750

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. De laet I, Viaene D, Vermeiren G, Schoonheydt K, Dits H, Malbrain ML (2007) Intra- and interobserver variability during in vitro validation of the CiMON intra-abdominal pressure measurement device. Acta Clin Belg Suppl 62:263–264

    Google Scholar 

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

    Google Scholar 

  22. Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91

    Article  PubMed  CAS  Google Scholar 

  23. Wauters J, Wilmer A (2007) Noosa, 2 years later… A critical analysis of recent literature. Acta Clin Belg 62(Suppl):33–43

    Google Scholar 

  24. Schachtrupp A, Wauters J, Wilmer A (2007) What is the best animal model for ACS? Acta Clin Belg 62(Suppl):225–232

    Google Scholar 

  25. Suominen PK, Pakarinen MP, Rautiainen P, Mattila I, Sairanen H (2006) Comparison of direct and intravesical measurement of intraabdominal pressure in children. J Pediatr Surg 41:1381–1385

    Article  PubMed  Google Scholar 

  26. Davis PJ, Koottayi S, Taylor A, Butt WW (2005) Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Med 31:471–475

    Article  PubMed  Google Scholar 

  27. Fusco MA, Martin RS, Chang MC (2001) Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 50:297–302

    PubMed  CAS  Google Scholar 

  28. Johna S, Taylor E, Brown C, Zimmerman G (1999) Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients. Crit Care (Lond) 3:135–138

    Article  Google Scholar 

  29. Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM (1994) Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med 20:588–590

    Article  PubMed  CAS  Google Scholar 

  30. Malbrain ML, Deeren DH (2006) Effect of bladder volume on measured intravesical pressure: a prospective cohort study. Crit Care 10:R98

    Article  PubMed  Google Scholar 

  31. De Waele J, Pletinckx P, Blot S, Hoste E (2006) Saline volume in transvesical intra-abdominal pressure measurement: enough is enough. Intensive Care Med 32:455–459

    Article  PubMed  CAS  Google Scholar 

  32. Ball CG, Kirkpatrick AW (2006) ‘Progression towards the minimum’: the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures. Crit Care 10:153

    Article  PubMed  Google Scholar 

  33. Johna S (2001) Can we use the bladder to estimate intra-abdominal pressure? J Trauma 51:1218

    Article  PubMed  CAS  Google Scholar 

  34. Cheatham ML, De Waele J, De Keulenaer B, Widder S, Kirkpatrick A, Cresswell B, Malbrain ML, Bodnar Z, Meija J, Reis R, Parr M, Schulze R, Compano S (2007) The effect of body position on intra-abdominal pressure measurement: a multicenter analysis. Acta Clin Belg 62(Suppl):246

    Google Scholar 

  35. De Waele J, Cheatham ML, De Keulenaer B, Widder S, Kirkpatrick A, Cresswell B, Malbrain ML, Bodnar Z, Meija J, Reis R, Parr M, Schulze R, Compano S (2007) The optimal zero reference transducer position for intra-abdominal pressure measurement: a multicenter analysis. Acta Clin Belg 62(Suppl):247

    Google Scholar 

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MLNGM is Founding President of the World Society on Abdominal Compartment Syndrome. MLNGM is member of the medical advisory board of Holtech Medical, Spiegelberg, and Pulsion Medical Systems. MLNGM received royalties from Holtech and Spiegelberg to a total amount of € 2500 in the year 2006, which was invested in organizing the Third WCACS in 2007. MLNGM holds a patent with PMS. The remaining authors have no financial involvement with any organization or entity with a financial interest in or in financial competition with the subject matter or materials discussed in the manuscript.

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Correspondence to Manu L. N. G. Malbrain.

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Malbrain, M.L.N.G., De laet, I., Viaene, D. et al. In vitro validation of a novel methodfor continuous intra-abdominalpressure monitoring. Intensive Care Med 34, 740–745 (2008).

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