Abstract
Background:
Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality rates. Therefore, the need for a good diagnostic tool to predict intra-abdominal hypertension (IAH) and progression to ACS is paramount. Bladder pressure (BP) has been used for several years for intra-abdominal pressure (IAP) measurement but has the disadvantage that it is not a continuous measurement. In this study, a single-lumen central venous catheter (CVC) is placed through the abdominal wall into the abdominal cavity to continuously and directly monitor the intraabdominal pressure (CDIAP). The aim of this study was to evaluate the use of CDIAP to measure BP as a representative of the true IAP.
Methods:
Both BP and CDIAP were prospectively recorded on a variety of surgical patients admitted to the intensive care unit (ICU) from March 2003 up to December 2004. At the end of the surgical procedure, the CVC was placed through the abdominal wall and connected to a pressure transducer. In addition, the BP was measured through the urine drainage port after clamping the catheter and filling the bladder with 50 ml of 0.9% saline. At least three paired measurements (BP and CDIAP) were performed for at least one day on the ICU in a standardized manner at preset time intervals on each patient. The paired measurements were compared using the Bland–Altman (B–A) method. Data are presented as mean ± standard deviation.
Results:
Over a period of 22 months (March 2003 until December 2004), 125 paired measurements of both BP and CDIAP were recorded on 25 patients. The mean age was 72.4 ± 6.6 years. Eighteen patients underwent central vascular surgery, and seven patients with peritonitis received laparotomy. The mean CDIAP was 11.4 ± 4.8 (range 2–30) mmHg, and the BP was 12.9 ± 5.3 (range 3–37) mmHg. The mean difference between CDIAP and BP was 1.6 ± 2.7 mmHg. There was an acceptable level of agreement (intraclass correlation 0.82) between IAP measured by BP and IAP measured via CDIAP.
Conclusion:
Continuous direct intra-abdominal pressure measurement proved that the BP measurement approach of Kron is representative of the IAP. CDIAP measurement is accurate and makes it easier for the nursing staff to be informed of the IAP.
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References
Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, Valdivia A, Ware DN, Moore FA. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 2003;54:848–859, (discussion 859–61).
Moore AF, Hargest R, Martin M, Delicata RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2004;91:1102–1110.
Loftus IM, Thompson MM. The abdominal compartment syndrome following aortic surgery. Eur J Vasc Endovasc Surg 2003;25:97–109.
Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997;174:667–672, discussion 663–72.
Ertel W, Oberholzer A, Platz A, Stocker R, Trentz O. Incidence and clinical pattern of the abdominal compartment syndrome after “damage-control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med 2000;28:1747–1753
Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg 2001;182:542–546.
Obeid F, Saba A, Fath J, Guslits B, Chung R, Sorensen V, Buck J, Horst M. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg 1995;130:544–754, (discussion 547–8).
Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects ofmassively increased intra-abdominal pressure in critically ill patients. Crit Care Med 1989;17:118–121.
Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 2004;30:357–371.
Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28–30.
Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1987;15:1140–1142.
Sugrue M. Intra-abdominal pressure: time for clinical practice guidelines?. Intensive Care Med 2002;28:389–391.
Balogh Z, Jones F, D’Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure measurement technique. Am J Surg 2004;188:679–684.
Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 1995;346:1085–1087.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310.
Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005;11:156–171.
Balogh Z, McKinley BA, Cox CS Jr, Allen SJ, Cocanour CS, Kozar RA, Moore EE, Miller IC, Weisbrodt NW, Moore FA. Abdominal compartment syndrome: the cause or effect of postinjury multiple organ failure. Shock 2003;20:483–492.
Collee GG, Lomax DM, Ferguson C, Hanson GC. Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med 1993;19:478–480.
Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intraabdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med 1994;20:588–590.
Vantrappen G, Janssens J, Peeters TL. The migrating motor complex. Med Clin North Am 1981;65:1311–1329.
Moore FA, Cocanour CS, McKinley BA, Kozar RA, DeSoignie RC, Von-Maszewski ME, Weisbrodt NW. Migrating motility complexes persist after severe traumatic shock in patients who tolerate enteral nutrition. J Trauma 2001;51:1075–1082.
Schachtrupp A, Tons C, Fackeldey V, Hoer J, Reinges M, Schumpelick V. Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model. Intensive Care Med 2003;29:1605–1608.
Engum SA, Kogon B, Jensen E, Isch J, Balanoff C, Grosfeld JL. Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome. J Pediatr Surg 2002;37:214–218.
Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 2001;50:297–302.
Brooks AJ, Simpson A, Delbridge M, Beckingham IJ, Girling KJ. Validation of direct intraabdominal pressure measurement using a continuous indwelling compartment pressure monitor. J Trauma 2005;58:830–832.
Shafik A, El-Sharkawy A, Sharaf WM. Direct measurement of intra-abdominal pressure in various conditions. Eur J Surg 1997;163:883–887.
Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000;49:621–626, (discussion 626–7).
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van Waes, O.J.F., Jaquet, J.B., Hop, W.C.J. et al. A Single-Lumen Central Venous Catheter for Continuous and Direct Intra-abdominal Pressure Measurement. Eur J Trauma 35, 532–537 (2009). https://doi.org/10.1007/s00068-008-8121-x
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DOI: https://doi.org/10.1007/s00068-008-8121-x