Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

doi:10.5847/wjem.j.1920-8642.2015.02.009

Abstract

Abstract:

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure (IAP) by measuring abdominal wall tension (AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit (ICU).
METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure (UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index (BMI) on baseline AWT (IAP<12 mmHg) were assessed using one-way analysis of variance.
RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP (R=0.986, P<0.01); the regression equation was Y=-1.369+9.57X (P<0.01). There were significant differences among the different respiratory phases and body positions (P<0.01). However, gender and BMI had no significant effects on baseline AWT (P=0.457 and 0.313, respectively).
CONCLUSIONS: There was a significant linear correlation between AWT and UBP and respiratory phase, whereas body position had significant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

Key words: Abdominal wall tension, Intra-abdominal pressure, Noninvasive monitoring, Abdominal compartment syndrome

Yuan-zhuo Chen, Shu-ying Yan, Yan-qing Chen, Yu-gang Zhuang, Zhao Wei, Shu-qin Zhou, Hu Peng. Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension[J]. World Journal of Emergency Medicine, 2015, 6(2): 137-141.

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References 17

1	Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39:1190-1206.
2	Chen H, Li F, Sun JB, Jia JG. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol 2008; 14:3541-3548.
3	Malbrain MLNG, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004; 30:822-829.
4	De Waele JJ, Leppäniemi AK. Intra-abdominal hypertension in acute pancreatitis. World J Surg 2009; 33:1128-1133.
5	Chen H, Li F, Sun JB, Jia JG. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol 2008; 14:3541-3548. pmid: 18567084
6	Hang Y, Chen Y, Lu LX, Zhu CQ. Acute hyperlipidemic pancreatitis in a pregnant woman. World J Emerg Med 2013; 4:311-313. pmid: 25215139
7	Wang YJ, Sun JB, Li F. Relationship between intra-abdominal pressure and severity in patients with severe acute pancreatitis. Chin J Emerg Med 2009; 18:632-635.
8	Guo YY, Liu ML, He XD, Jiang CQ, Liu RL. Functional changes of intestinal mucosal barrier in surgically critical patients. World J Emerg Med 2010; 1:205-208. pmid: 25214969
9	De Laet IE, Hoste EA, De Waele JJ. Survey on the perception and management of the abdominal compartment syndrome among Belgian surgeons. Acta Chir Belg 2007; 107:648-652.
10	Otto J, Kaemmer D, Höer J, Jansen M, Schumpelick V, Strik M, et al. Importance of abdominal compartment syndrome in Germany: A questionnaire. Anaesthesist 2009; 58:607-610.
11	Ravishankar N, Hunter J. Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: Anational postal questionnaire study. Br J Anaesth 2005; 94:763-766. pmid: 15764629
12	Van Ramshorst GH, Lange JF, Goossens RH, Agudelo NL, Kleinrensink GJ, Verwaal M, et al. Non-invasive measurement of intra-abdominal pressure: a preliminary study. Physiol Meas 2008; 29:N41-N47. pmid: 18641425
13	van Ramshorst GH, Salih M, Hop WC, van Waes OJ, Kleinrensink GJ, Goossens RH, et al. Noninvasive assessment of intra-abdominal pressure by measurement of abdominal wall tension. J Surg Res 2011; 171:240-244. pmid: 20462598
14	Cheatham ML, De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med 2009; 37:2187-2190.
15	Vasquez DG, Berg-Copas GM, Wetta-Hall R. Influence of semirecumbent position on intra-abdominal pressure as measured by bladder pressure. J Surg Res 2007; 139:280-285. pmid: 17161433
16	Sugerman H, Windsor A, Bessos M, Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med 1997; 241:71-79.
17	Wilson A, Longhi J, Goldman C, McNatt S. Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index. J Trauma 2010; 69:78-83. pmid: 20622581

UBP	Male (n)	Female (n)	Age (year)	BMI
UBP<12 mmHg	9	13	68±18	23.5±4.4^*
12≤UBP≤20 mmHg	17	7	71±15	25.7±5.1
UBP>20 mmHg	2	3	62±10	26.1±4.7

Variables	Supine position		30° supine position
Variables	Late inspiration	Late expiration	Late inspiration	Late expiration
AWT (N/mm)	1.65±0.52	1.45±0.54	1.25±0.30	1.07±0.35
t value	9.24^a	18.06^b	17.62^c	10.05^d
P value	<0.01^a	<0.01^b	<0.01^c	<0.01^d

Variables	Gender		BMI
Variables	Male	Female	BMI<18.5	18.5≤BMI≤25	BMI>25
Cases (n)	9	13	6	9	6
AWT(N/mm)	1.09±0.29	1.01±0.34	0.91±0.30	1.02±0.35	1.16±0.28
F value	0.47		1.21
P value	0.457		0.313

[1]	Hui-ming Zhu, Shao-qing Guo, Xiu-min Liao, Li Zhang, Li Cai. Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome [J]. World Journal of Emergency Medicine, 2015, 6(1): 23-28.
[2]	Xiao-yan Li, Xiao-bo Wang, Xiu-feng Liu, Shu-gui Li. Prevalence and risk factors of organ failure in patients with severe acute pancreatitis [J]. World Journal of Emergency Medicine, 2010, 1(3): 201-204.