Abstract and Background
Abstract
Background: The gold standard for assessment of intraabdominal pressure (IAP) is via intravesicular pressure measurement (IVP). This accepted technique has some inherent problems, e.g. indirectness. Aim of this clinical study was to assess direct IAP measurement using an air-capsule method (ACM) regarding complications risks and agreement with IVP in patients undergoing abdominal surgery.
Methods: A prospective cohort study was performed in 30 patients undergoing elective colonic, hepatic, pancreatic and esophageal resection. For ACM a Probe 3 (Spiegelberg, Germany) was placed on the greater omentum. It was passed through the abdominal wall paralleling routine drainages. To compare ACM with IVP t-testing was performed and mean difference as well as limits of agreement were calculated.
Results: ACM did not lead to complications particularly with regard to organ lesion or surgical site infection. Mean insertion time of ACM was 4.4 days (min-max: 1-5 days). 168 pairwise measurements were made. Mean ACM value was 7.9 ± 2.7 mmHg while mean IVP was 8.4 ± 3.0 mmHg (n.s). Mean difference was 0.4 mmHg ± 2.2 mmHg. Limits of agreement were -4.1 mmHg to 5.1 mmHg.
Conclusion: Using ACM, direct IAP measurement is feasible and uncomplicated. Associated with relatively low pressure ranges (<17 mmHg), results are comparable to bladder pressure measurement.
Background
Intra-abdominal hypertension (IAH) is defined by a sustained or repeated pathological elevation of intra-abdominal pressure (IAP) to more than 12 mmHg. This condition has been shown to be an independent factor of organ dysfunction and -failure and may lead to the abdominal compartment syndrome (ACS). Both, IAH and ACS have been observed to occur in any patient population needing intensive care with an incidence rate of 50 and 8% respectively.
Clinical examination of the abdomen in order to detect hypertension has been demonstrated to have an insufficient sensitivity. Therefore IAP measurement has been recommended in patients at risk to develop IAH and ACS. The gold standard for intermittent IAP measurement is the intra-vesicular pressure measurement (IVP). This measurement principle is widely accepted in the clinical regard but has inherent problems with regard to intrinsic bladder wall tension, reference level, body position, discontinuity and indirectness.
In a porcine model an air-capsule-technique for the direct measurement was applied and this technique showed a high precision and a good agreement with bladder pressure measurement. Although direct intraabdominal pressure measurement is routinely used to validate indirect methods it has not been applied for monitoring of patients. It can be argued, that direct intraabdominal pressure measurement is difficult and bears additional risks. However, this has not been examined yet. Aim of the underlying study was to evaluate the air-capsule technique for direct measurement with regard to feasibility and agreement with bladder pressure measurement in patients undergoing abdominal surgery.