INTRA-ABDOMINAL PRESSURE MEASUREMENTS IN LATERAL DECUBITUS VERSUS SUPINE POSITION

Abstract

Objective: Intra-abdominal pressure (IAP) has traditionally been measured in the supine position, however, measuring the pressure in lateral semi-recumbent position has not been studied.Design: A single centre prospective 1-day study.Patients: 10 patients admitted for more then 24 hours who were mechanically ventilated and had an indwelling urinary catheter.Methods: Inclusion criteria included were age > 18 years, sedated to a RASS score of -5 and mechanically ventilated. The pressures were measured via the bladder with the mid-axillary line as zero reference point. When patients were nursed in lateral decubitus, pressures were measured and compared immediately to the supine position.Results: 10 patients were included with a total of 60 measurements. The male/female ratio was 9:1 with a mean APACHE Ð score of 11.5 [95% CI 4.8-22.4], SAPS 2 of 31.5 [95% CI 8.9-35.8] and SOFA score of 4.0 [95% CI 1.8-7.2]. Four patients were medical and 6 were surgical. The mean IAP at different time intervals (morning, afternoon and evening) in lateral and supine position were 10.9 ± 2.0 (in mmHg) vs 6.6 ±3.2 (SD with p < 0.001); 11.0±4.0 vs 5.4±2.2 (p < 0.0005) and 11.6±3.8 vs 7.8±3.0 (p< 0.001). Overall, the LSP did not change significantly (p= 0.76), but the SP did (p=0.006) with the afternoon reading being significantly lower than the evening measurement. However, the trend in the difference (LSP minus SP) was not significant (p=0.43).Conclusion: There was a significant statistical difference in the pressures measured in LSP versus SP. The LSP position should not be used to measure IAP.