| Abstract: INTRODUCTION: Definitions for intra-abdominal hypertension and abdominal compartment syndrome stand or fall with the reproducibility and accuracy of the IAP measurement (1-3). The aim of this study is to validate a novel fully-automated continuous technique to measure IAP via a balloon-tipped catheter connected to an IAP monitor (Spiegelberg, Hamburg, Germany) versus a bladder FoleyManometer (Holtech Medical, Copenhagen, Denmark) and to look for the COVA (SD divided by mean) for IAP and APP during different 24h periods.
METHODS: IAP was estimated using 2 different methods: via the bladder (IBP) and via a balloon-tipped gastric catheter (IGP) connected to an IAP monitor. In total 2029 IGP and 705 IBP measurements were performed in 22 sedated mechanically ventilated ICU patients. Correlation between IGP and IBP was studied in 705 paired samples. The M/F ratio was 1/1, age 63±11.6, APACHE-II 23±9.5, SAPS-II 55±16.8.
RESULTS: The values for IAP (mmHg) were 9.7±3.3 (IGP) vs 9.9±3.2 (IBP). There was a good correlation: IBP= 0.86xIGP +1.6 (R2=0.81, p<0.0001). Bland and Altman analysis showed good agreement: IGP was almost identical to IBP with a mean bias of –0.2±1.5(SD) mmHg (95%CI –0.3 to 0); the limits of agreement (LA) were –3.1 to 2.8 mmHg (95%CI –3.3 to –2.9 for the LLA and 2.6 to 3 for the ULA). The COVA was 18.6±7.6% for IGP (range 4-46), 16.8±12.2% for IBP(range 0-58) and 14.4±5.9 for APP (range 5-48).
CONCLUSION: Estimation of IAP via IGP or IBP is feasible. The COVA for these parameters and APP in sedated mechanically ventilated patients is around 15 to 20% (ranging from 5 up to 50%) in a 24h period and thus varies substantially. These variations may even be more pronounced in non-sedated patients. Therefore IAP and APP are continuous variables like any other pressure and should be monitored as often as possible during the day to adapt treatment accordingly.
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