Skip to main content
SpringerLink
Log in

Comparison of a new device for the continuous intra-gastric measurement of intra-abdominal pressure (CiMon) with direct intra-peritoneal measurements in cirrhotic patients during paracentesis

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

Abstract

Objective

To evaluate a new commercially available system for the intra-gastric measurement of intra-abdominal pressure (IAP).

Design and setting

Prospective interventional trial in an intensive care unit of a university hospital.

Patients

Ten patients with cirrhosis and tense ascites scheduled for paracentesis and instrumented with a ballon-tipped nasogastric tube.

Intervention

Intermittent paracentesis with repeat paired measurements of IAP.

Measurements and results

Intra-abdominal pressure was measured directly through the paracentesis catheter using a scaled measurement gauge. Simultaneously, intra-gastric measurements were performed with the CiMon device (Pulsion Medical Systems, Munich, Germany), by means of a ballon-tipped nasogastric tube connected to a pressure transducer. The range of IAP was 6.5–28 mmHg for direct measurements and 3.7–16 mmHg for measurements obtained with the CiMon device. The regression equation according to Passing and Bablok for the two methods had an intercept of 0.054 (95% CI–1.475–1.669) and a slope of 0.674 (95% CI 0.538–0.813). The cusum test showed a significant deviation from linearity (P < 0.05). In the Bland–Altman test bias and limits of agreement were – 4.9 (±6.8) mmHg or, expressed as percentage of the average, −44% (±49%).

Conclusion

Intra-gastric measurments of IAP using the CiMon device were not reliable enough to be clinically useful in these ascitic patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ACS:

Abdominal compartment syndrome

BMS:

Body mass index

IAH:

Intra-abdominal hypertension

IAP:

Intra-abdominal pressure

MELD:

Model of end-stage liver disease

References

  1. 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 

  2. 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 

  3. Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E (2008) Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 36:1823–1831

    Article  PubMed  Google Scholar 

  4. Umgelter A, Reindl W, Wagner KS, Franzen M, Stock K, Schmid RM, Huber W (2007) Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: a prospective uncontrolled trial. Crit Care 12:R4

    Article  Google Scholar 

  5. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman KAW (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 

  6. Schachtrupp A, Wauters J, Wilmer A (2007) What is the best animal model for ACS? Acta Clin Belg Suppl 1:225–232

    Google Scholar 

  7. Sugrue M (2005) Abdominal compartment syndrome. Curr Opin Crit Care 11:333–338

    Article  PubMed  Google Scholar 

  8. 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 

  9. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman 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 

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

    Article  PubMed  CAS  Google Scholar 

  11. Zengerink I, McBeth PB, Zygun DA, Ranson K, Ball CG, Laupland KB, Widder S, Kirkpatrick AW (2008) Validation and experience with a simple continuous intra-abdominal pressure measurement technique in a multidisciplinary medical/surgical critical care unit. J Trauma 64:1159–1164

    Article  PubMed  Google Scholar 

  12. Passing H, Bablok W (1983) A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, Part I. J Clin Chem Clin Biochem 21:709–720

    PubMed  CAS  Google Scholar 

  13. Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160

    Article  PubMed  CAS  Google Scholar 

  14. Bradley SE, Bradley GP (1947) The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 26:1010–1022

    Article  PubMed  CAS  Google Scholar 

  15. 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 

  16. Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N (2007) Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 34:707–713

    Article  PubMed  Google Scholar 

  17. Malbrain ML, De laet I, Viaene D, Schoonheydt K, Dits H (2008) In vitro validation of a novel method for continuous intra-abdominal pressure monitoring. Intensive Care Med 34:740–745

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. Davis PJ, Koottayi S, Taylor A, Butt WW (2005) Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Med 32:471–475

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Valentin Becker, Roland M. Schmid & Andreas Umgelter

Authors
  1. Valentin Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roland M. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Umgelter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Umgelter.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM1 (TIFF 5490 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, V., Schmid, R.M. & Umgelter, A. Comparison of a new device for the continuous intra-gastric measurement of intra-abdominal pressure (CiMon) with direct intra-peritoneal measurements in cirrhotic patients during paracentesis. Intensive Care Med 35, 948–952 (2009). https://doi.org/10.1007/s00134-009-1451-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1451-2

Keywords

Search

Navigation