Abstract
IntroductionIntra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality. The techniques most commonly used to estimate intra-abdominal pressure are measurements of bladder and gastric pressures. The bladder technique requires that the bladder be infused with a certain amount of saline, to ensure that there is a conductive fluid column between the bladder and the transducer. The aim of this study was to evaluate the effect of different volumes and temperatures of infused saline on bladder pressure measurements in comparison with gastric pressure.MethodsThirteen mechanically ventilated critically ill patients (11 male; body mass index 25.5 ± 4.6 kg/m2; arterial oxygen tension/fractional inspired oxygen ratio 225 ± 48 mmHg) were enrolled. Bladder pressure was measured using volumes of saline from 50 to 200 ml at body temperature (35 to 37°C) and room temperature (18 to 20°C).ResultsBladder pressure was no different between 50 ml and 100 ml saline (9.5 ± 3.7 mmHg and 13.7 ± 5.6 mmHg), but it significantly increased with 150 and 200 ml (21.1 ± 10.4 mmHg and 27.1 ± 15.5 mmHg). Infusion of saline at room temperature caused a significantly greater bladder pressure compared with saline at body temperature. The lowest difference between bladder and gastric pressure was obtained with a volume of 50 ml.ConclusionThe bladder acts as a passive structure, transmitting intra-abdominal pressure only with saline volumes between 50 ml and 100 ml. Infusion of a saline at room temperature caused a higher bladder pressure, probably because of contraction of the detrusor bladder muscle.
Highlights
Intra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality
The aim of this study was to evaluate Intra-abdominal pressure (IAP) estimated by bladder pressure, measured with the bladder infused with different volumes of saline at room and body temperatures, in comparison with intra-gastric pressure (IGP)
It has been proposed that the appropriate amount of volume is that required to create a fluid column without interposed air [39]. These findings clearly indicate that the intra-bladder pressure (IBP) can overestimate IAP when large volumes of saline are infused, the possible mechanisms involved are still not clearly understood
Summary
Intra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality. Intra-abdominal hypertension (IAH), defined as an abnormal increase in IAP, can be common in critically ill patients, being present in 18% to 81% of the patients depending on the cut-off level used [2,3,4,5,6,7,8]. Several clinical conditions such as accumulation of blood, ascites, retroperitoneal haematoma, bowel oedema, necrotizing pancreatitis, massive fluid resuscitation, packing after control laparotomy and closure of a swollen noncompliant abdominal wall may induce IAH [3,9]. Surgical decompression remains the only definitive therapy in the case of substantial IAH, and the IAP is lower after decompression, mortality remains considerable [18,19]
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