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Feasibility analysis of a novel non-invasive ultrasonographic method for the measurement of intra-abdominal pressure in the intensive care unit

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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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Data Availability

Derived data supporting the findings of this study in addition to the processing algorithms are available from the corresponding author on request.


  1. Carter BM, Howard C. A 6th vital sign–potential use of nasogastric tube for intra-abdominal pressure monitoring method to detect feeding intolerance in very low birth-weight Preterm Infants (< 1500 g). Adv Neonatal Care. 2015;15(3):176–81.

    Article  PubMed  Google Scholar 

  2. Kirkpatrick AW, et al. WSACS–The Abdominal Compartment Society. A Society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems. Anaesthesiol Intensive Ther. 2015;47(3):191–4.

    Article  PubMed  Google Scholar 

  3. Kirkpatrick AW, et al. Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017. Anaesthesiol Intensive Ther. 2017;49(2):83–7.

    Article  PubMed  Google Scholar 

  4. Sugrue M, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg. 2002;26(12):1428–31.

    Article  PubMed  Google Scholar 

  5. Jacobs R et al. Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review. Life (Basel), 2022. 12(9).

  6. Minini A, Emara MM, Malbrain MLNG et al. Polycompartment Syndrome, in Compartment Syndrome, F. Coccolini, Editors. 2021, Springer International Publishing: Cham. p. 101–121.

  7. De Laet I, Hoste E, De Waele JJ. Transvesical intra-abdominal pressure measurement using minimal instillation volumes: how low can we go? Intensive Care Med. 2008;34(4):746–50.

    Article  PubMed  Google Scholar 

  8. De Waele JJ, et al. The effect of different reference transducer positions on intra-abdominal pressure measurement: a multicenter analysis. Intensive Care Med. 2008;34(7):1299–303.

    Article  PubMed  Google Scholar 

  9. Al-Hwiesh A, et al. Intraperitoneal pressure and intra-abdominal pressure: are they the same? Perit Dial Int. 2011;31(3):315–9.

    Article  PubMed  Google Scholar 

  10. Khanna AK, Rola P, Malbrain M. Biomarkers for intra-abdominal pressure: another tool in the toolbox? Eur Heart J Acute Cardiovasc Care. 2022;11(6):461–3.

    Article  PubMed  Google Scholar 

  11. David M, et al. Intra-abdominal pressure monitoring by Surface Bioimpedance Estimation. J Phys: Conf Ser. 2019;1272(1):012013.

    Google Scholar 

  12. Tang H, et al. Deep Domain Adaptation for Predicting Intra-Abdominal pressure with multichannel attention Fusion Radar Chip. Adv Intell Syst. 2022;4(5):2100209.

    Article  Google Scholar 

  13. Tayebi S, et al. Non-invasive intra-abdominal pressure measurement by means of transient Radar Method: in Vitro Validation of a Novel Radar-Based Sensor. Sensors. 2021;21(18):5999.

    Article  PubMed  PubMed Central  Google Scholar 

  14. David M, et al. Non-invasive indirect monitoring of intra-abdominal pressure using microwave reflectometry: system design and proof-of-concept clinical trial. J Clin Monit Comput. 2021;35(6):1437–43.

    Article  PubMed  Google Scholar 

  15. Cheatham ML, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis*. Crit Care Med; 2009.

  16. Cheatham ML et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations Intensive Care Med, 2007. 33(6): p. 951 – 62.

  17. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30(3):357–71.

    Article  PubMed  Google Scholar 

  18. Malbrain ML, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004;30(5):822–9.

    Article  PubMed  Google Scholar 

  19. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  PubMed  Google Scholar 

  20. Tayebi S et al. Pre-Clinical Validation of A Novel Continuous Intra-Abdominal Pressure Measurement Equipment (SERENNO) Life (Basel), 2022. 12(8).

  21. Otto J, et al. Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note. BMC Surg. 2009;9:5.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Malbrain ML, et al. Can the abdominal perimeter be used as an accurate estimation of intra-abdominal pressure? Crit Care Med. 2009;37(1):316–9.

    Article  PubMed  Google Scholar 

  23. van Ramshorst GH, et al. Non-invasive measurement of intra-abdominal pressure: a preliminary study. Physiol Meas. 2008;29(8):N41–7.

    Article  PubMed  Google Scholar 

  24. Tayebi S, et al. A concise overview of non-invasive intra-abdominal pressure measurement techniques: from bench to bedside. J Clin Monit Comput. 2021;35(1):51–70.

    Article  PubMed  Google Scholar 

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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.


The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations



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.

Corresponding author

Correspondence to Kay Choong See.

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Ethics Approval

The study protocol was approved by the institutional review board of the local ethics committee (study number B/09/032).

Consent to participate

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, 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 ( 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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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.


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.


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.


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).

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