Assessment of Intra-Abdominal Pressure with a Novel Continuous Bladder Pressure Monitor-A Clinical Validation Study.

INTRODUCTION: Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor. METHODS: Adults having laparoscopic surgery and requiring urinary catheter intra-operatively were recruited to this single-arm validation study. IAP measurements using the novel monitor and a gold-standard foley manometer were compared. After anesthesia induction, a pneumoperitoneum was induced through a laparoscopic insufflator, and five randomly pre-defined pressures (between 5 and 25 mmHg) were achieved and simultaneously measured via both methods in each participant. Measurements were compared using Bland-Altman analysis. RESULTS: In total, 29 participants completed the study and provided 144 distinct pairs of pressure measurements that were analyzed. A positive correlation between the two methods was found (R2 = 0.93). There was good agreement between the methods, with a mean bias (95% CI) of -0.4 (-0.6, -0.1) mmHg and a standard deviation of 1.3 mmHg, which was statistically significant but of no clinical importance. The limits of agreement (where 95% of the differences are expected to fall) were -2.9 and 2.2 mmHg. The proportional error was statistically insignificant (p = 0.85), suggesting a constant agreement between the methods across the range of values tested. The percentage error was 10.7%. CONCLUSIONS: Continuous IAP measurements using the novel monitor performed well in the clinical setup of controlled intra-abdominal hypertension across the evaluated range of pressures. Further studies should expand the range to more pathological values.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis / 中华危重病急救医学

Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.

Application of intra-abdominal pressure monitoring in early enteral nutrition after abdominal surgery.

OBJECTIVE: To explore the effect of intra-abdominal pressure monitoring in early enteral nutrition therapy after abdominal surgery. METHODS: 164 patients who underwent elective abdominal surgery in our hospital from January 2019 to January 2020 were selected and divided into an observation group and a control group according to the random number table method, with 82 cases in each group. On the basis of conventional enteral nutrition nursing, the control group received conventional gastric residual monitoring, and the observation group received intra-abdominal pressure monitoring. The clinical treatment effect, intra-abdominal pressure, incidence of intra-abdominal hypertension, APACHE-II score, and enteral nutrition tolerance were compared. Correlation of early enteral nutrition intolerance and intra-abdominal pressure was analyzed in the ROC curve. RESULTS: The time of abdominal pain relief, adjusted enteral nutrition, and hospitalization were significantly shorter in the observation group (P < 0.05). The intra-abdominal pressure, intra-abdominal hypertension rate, and APACHE-II scores were comparable before treatment (P > 0.05) and all were significantly reduced after treatment in the two groups (P < 0.05). After treatment, the above items were significantly lower in the observation group (P < 0.05). The enteral nutrition's tolerance level of the observation group was significantly higher than that of the control group (P < 0.05). The Pearson correlation analysis revealed that the early enteral nutrition tolerance of patients after abdominal surgery was correlated with the level of intra-abdominal pressure (P < 0.05). The ROC reveled that the baseline level of intra-abdominal pressure and the average level of intra-abdominal pressure 3 days before enteral nutrition were of diagnostic values in predicting the intolerance during enteral nutrition. CONCLUSION: Intraperitoneal pressure monitoring can significantly improve patients' symptoms, and it should be accurately measured for doctors to make timely diagnoses and provide proper treatments.

The monitoring of intra-abdominal pressure in critically ill patients / 中华危重病急救医学

Objective To monitor intra-abdominal pressure (IAP) in critically ill patients.Methods A prospective cohort study was conducted.IAP was measured through the bladder technique.Patients were screened for intra-abdominal hypertension (IAH,IAP ≥ 12 mmHg,1 mmHg=0.133 kPa) upon ICU admission.The patients with IAH/abdominal compartment syndrome (ACS) were given appropriate treatment and management for IAH and/or ACS.Mean arterial pressure (MAP),IAP,abdominal perfusion pressure (APP),filtration gradient (FG) and serum creatinine (Cr) were determined in patients with or without IAH,as well as in survivors and non-survivors.Results The entire protocol of IAP measurement was completed in 88 patients.Number of IAH and ACS patients was 25 (28.4％) and 2 (2.3％),respectively.The number of survivors was 80 (90.9％),with 8 (9.1％) non-survivors.Compared with non-IAH patients,IAP and SCr were increased in IAH patients [IAP (mmHg):14.16 ± 2.43 vs.8.13 ± 2.28,t=10.984,P=0.000; SCr (μmol/L):126.72 ± 83.02 vs.73.41 ± 37.59,t=3.087,P=0.005],with a lower FG (mmHg:59.32 ± 17.08 vs.70.24 ± 15.03,t=-2.956,P=0.004).There were no significant differences in MAP and APP between IAH group and non-IAH group [MAP (mmHg):79.18 ± 12.33 vs.88.71 ± 17.34,t=-1.368,P=0.190; APP (mmHg):73.40 ± 16.11 vs.78.37 ± 14.32,t=-1.415,P=0.161].Compared with survivors,non-survivors showed significantly lower APP and FG [APP (mmHg):60.88 ± 14.58 vs.78.56 ± 14.06,t=3.382,P=0.001 ; FG (mmHg):50.38 ± 16.18 vs.68.81 ± 15.44,t=3.208,P=0.002],and higher SCr (μmol/L:129.12 ±83.62 vs.84.36 ± 55.15,t=-2.082,P=0.040).There was no significant difference in IAP and MAP between survivors and non-survivors [MAP (mmHg):71.00 ± 25.46 vs.84.38 ± 13.53,t =1.224,P=0.238 ; IAP (mmHg):10.62 ±5.34 vs.9.76 ± 3.40,t=-0.647,P=0.519].Conclusions Earlier IAP measurements in critically ill patients are essential for the detection of IAH/ACS and renal injury.With appropriate management of IAH/ACS,significant decrease in morbidity and mortality of patients has been achieved.

Continuous intra-abdominal pressure monitoring.

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can develop within 12 hours of ICU admission in high-risk patients. Until recently the intermittent intra-abdominal pressure (IAP) measurement via the urinary catheter was the clinical standard. This is a relatively labour intensive technique and its intermittent nature could prevent timely recognition of significant changes in IAP. The historical continuous IAP (CIAP) measurements were poorly reproducible (gastric route) or invasive/impractical (direct measurement). The aim of this paper is to review the current evidence on CIAP monitoring. METHODS: A broad Medline search of the English literature was performed using the terms of "intra abdominal pressure" and "continuous". This result was analysed based on the title and abstract. Only original clinical studies with continuous IAP measurement were considered in this review. New techniques of CIAP monitoring evaluated in large animal models are discussed as potential future directions. RESULTS: There is a growing evidence of measuring (monitoring) CIAP using several techniques (gastric, direct abdominal, inferior vena cava, and urinary bladder. The strongest evidence supports the direct abdominal, the gastric and the bladder route. From these three techniques the CIAP monitoring via the bladder has excellent agreement with the current standard of intermittent bladder pressure measurement. While the direct measurement could be very accurate it is an invasive method and feasible in patient who underwent laparotomy or laparoscopy. CONCLUSIONS: Until a better technique is available the CIAP monitoring via the bladder or stomach should be considered as the standard for continuous monitoring of the IAP. It is a less labour intensive, safe, less invasive and reliable method.