Abstract
Increased intra-abdominal pressure (IAP) is an important vital sign in critically ill patients and has a negative impact on morbidity and mortality. This study aimed to validate a novel non-invasive ultrasonographic approach to IAP measurement against the gold standard intra-bladder pressure (IBP) method. We conducted a prospective observational study in an adult medical ICU of a university hospital. IAP measurements using ultrasonography by two independent operators, with different experience levels (experienced, IAPUS1; inexperienced, IAPUS2), were compared with the gold standard IBP method performed by a third blinded operator. For the ultrasonographic method, decremental external pressure was applied on the anterior abdominal wall using a bottle filled with decreasing volumes of water. Ultrasonography looked at peritoneal rebound upon brisk withdrawal of the external pressure. The loss of peritoneal rebound was identified as the point where IAP was equal to or above the applied external pressure. Twenty-one patients underwent 74 IAP readings (range 2–15 mmHg). The number of readings per patient was 3.5 ± 2.5, and the abdominal wall thickness was 24.6 ± 13.1 mm. Bland and Altman’s analysis showed a bias (0.39 and 0.61 mmHg) and precision (1.38 and 1.51 mmHg) for the comparison of IAPUS1 and IAPUS2 and vs. IBP, respectively with small limits of agreement that were in line with the research guidelines of the Abdominal Compartment Society (WSACS). Our novel ultrasound-based IAP method displayed good correlation and agreement between IAP and IBP at levels up to 15 mmHg and is an excellent solution for quick decision-making in critically ill patients.
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Derived data supporting the findings of this study in addition to the processing algorithms are available from the corresponding author on request.
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Acknowledgements
The authors wish to thank the physicians and nurses of the Medical Intensive Care Unit, National University Hospital, Singapore, for their enthusiasm and support for this study. The authors of the ETRO department acknowledge the “SB Ph.D. fellow at FWO” (“SB-doctoraatsbursaal van het FWO”), Fonds Wetenschappelijk Onderzoek—Vlaanderen, Research Foundation—Flanders, project number: 1S51122N. No other (financial) support was provided.
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All authors contributed to the study conception and design. The first draft of the manuscript was written by Kay Choong See and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study protocol was approved by the institutional review board of the local ethics committee (study number B/09/032).
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Written informed consent was obtained from all subjects involved in the study.
Competing interests
M.L.N.G.M. is Professor of Critical Care Research at the 1st Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland. He is co-founder, past-President, and current Treasurer of WSACS (The Abdominal Compartment Society, http://www.wsacs.org). He is member of the medical advisory Board of Pulsion Medical Systems (part of Getinge group), Serenno Medical, Potrero Medical, and Baxter, and consults for BBraun, Becton Dickinson, ConvaTec, Spiegelberg, and Holtech Medical. He received speaker’s fees from PeerVoice. He is co-founder and President of the International Fluid Academy (IFA). The IFA (http://www.fluidacademy.org) is integrated within the not-for-profit charitable organization iMERiT, the International Medical Education and Research Initiative, under Belgian law. The other authors have no potential conflicts of interest in relation to the contents of this paper.
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10877_2023_1024_MOESM1_ESM.wmv
Supplementary Material 1: Online resource 1. Video recording of peritoneal lining when IAP is higher than the external pressure. In this case, no peritoneal rebound can be observed.
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Supplementary Material 2: Online resource 2. Video recording of the peritoneal lining when IAP is lower than the external pressure. In this situation, peritoneal rebound can be observed immediately after the brisk removal of the external pressure.
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Supplementary Material 3: Online resource 3. Intra-class correlation coefficient (ICC) for intra-bladder pressure (IBP) and IAPus. As can be seen, a relatively high (single and average measures) ICC was observed for the recorded data, which represents the reliability of the measurements.
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Supplementary Material 4: Online resource 4. Bland and Altman?s analysis between results of the experienced (IAPus1) and inexperienced (IAPus2) operators. The small bias (0.23 mmHg) and precision (0.62 mmHg) shows excellent agreement between the measurements by experienced and inexperienced operators.
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See, K.C., Tayebi, S., Sum, C.L. et al. Feasibility analysis of a novel non-invasive ultrasonographic method for the measurement of intra-abdominal pressure in the intensive care unit. J Clin Monit Comput 37, 1351–1359 (2023). https://doi.org/10.1007/s10877-023-01024-2
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DOI: https://doi.org/10.1007/s10877-023-01024-2