116 Measuring of Intra-Abdominal Pressure in Critically Ill Children by Nurses

Abstract

Objective of the study: Delayed diagnosis of increased intra-abdominal pressure in PICU patients increases morbidity and mortality rates. In 2007 our PICU implemented a protocol for indirect intra-abdominal pressure (IAP) measurements by an indwelling bladder catheter using a pressure transducer. One of the indications to start IAP measurement is an increased abdominal distension. The aim of this study was to evaluate the effects of this protocol, including the nurses' compliance. Methods: This retrospective study included patients admitted between 2007-2009. Children who underwent IAP measurements and/or abdominal girth measurements were identified from the Patient Data Management System and their records were analyzed. Results: Over the study period 36 children (19 male) with a mean age of 23 months (±49.3) underwent IAP measurements and 175 underwent three or more abdominal girth measurements. Both measurements were performed in 23 children. IAP measurements were mostly performed in neonates (52.8%) after closure of abdominal wall defects. The median number of IAP measurements was 14 (range 3-79); the median IAP was 8 mmHg (range 1-44). Eleven children (31%) had an IAP > 20 mmHg, indicating abdominal compartment syndrome. Most patients were treated conservatively and three underwent a surgical intervention. Conclusions: This study shows that after implementation of the IAP protocol nurses most often applied abdominal girth measurements in cases of suspected increased intra-abdominal pressure. We can conclude the nurses' compliance is moderate with IAP protocol. Strategies should be used to improve this.