Intra-abdominal Pressure Monitoring Research Articles

Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries

PurposeNon-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. MethodA prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. ResultsIntra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. ConclusionAs a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.

Validation of continuous intraabdominal pressure measurement: feasibility and accuracy assessment using a capsular device in in-vivo studies

BackgroundMonitoring Intraabdominal Pressure (IAP) is essential in critical care, as elevated IAP can lead to severe complications, including Abdominal Compartment Syndrome (ACS). Advances in technology, such as digital capsules, have opened new avenues for measuring IAP non-invasively. This study assesses the feasibility and effectiveness of using a capsular device for IAP measurement in an animal model.MethodIn our controlled experiment, we anesthetized pigs and simulated elevated IAP conditions by infusing CO2 into the peritoneal cavity. We compared IAP measurements obtained from three different methods: an intravesical catheter (IAPivp), a capsular device (IAPdot), and a direct peritoneal catheter (IAPdir). The data from these methods were analyzed to evaluate agreement and accuracy.ResultsThe capsular sensor (IAPdot) provided continuous and accurate detection of IAP over 144 h, with a total of 53,065,487 measurement triplets recorded. The correlation coefficient (R²) between IAPdot and IAPdir was excellent at 0.9241, demonstrating high agreement. Similarly, IAPivp and IAPdir showed strong correlation with an R² of 0.9168.ConclusionThe use of capsular sensors for continuous and accurate assessment of IAP marks a significant advancement in the field of critical care monitoring. The high correlation between measurements from different locations and methods underscores the potential of capsular devices to transform clinical practices by providing reliable, non-invasive IAP monitoring.

Knowledge, attitudes, and practices (KAP) regarding intra-abdominal pressure monitoring among pediatric intensive care nurses: A cross-sectional study

ObjectivesThis study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice. MethodsThis descriptive cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment tool was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items. ResultsThe overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44 ± 6.46, with a scoring rate of 69.3%. Nurses wh-o have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged > 30 (P < 0.05). Among the participants, 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP. ConclusionsPediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.

Subcutaneous emphysema associated with laparoscopic or robotic abdominal surgery: a retrospective single-center study.

Subcutaneous emphysema (SCE) is a common complication in laparoscopic surgery. However, its precise incidence and impact on the clinical course are partially known. In this study, the incidence and risk factors of SCE were retrospectively analyzed. Patients who underwent laparoscopic/robotic abdominal surgery (e.g., gastrointestinal, hepatobiliary, gynecologic, and urologic surgery) between October 2019 and September 2022 were retrospectively analyzed. The presence of SCE was confirmed by either conclusive findings obtained through chest/abdominal X-ray examination immediately after operation, or intraoperative palpation conducted by nurses. X-ray examination was performed in the operation room before extubation. A total of 2503 patients treated with laparoscopic/robotic abdominal surgery between October 2019 and September 2022 were identified and all of them were included in the analysis. SCE was confirmed in 23.1% of the patients (i.e., 577/2503). SCE was identified by X-ray examination in 97.6% of the patients. Extubation failure was observed in 10 patients; however, pneumothorax was not observed. Female sex (odds ratio [OR]: 2.09; 95% confidence interval [95%CI]: 1.69-2.57), age ≥ 80years (OR 1.63; 95%CI 1.19-2.22), body mass index < 20 (OR 1.32; 95%CI 1.06-1.65), operation time > 360min (OR 1.97; 95%CI 1.53-2.54), robotic surgery (OR 2.54; 95%CI 1.91-3.38), maximum intraabdominal pressure with CO2 > 15mmHg (OR 1.79; 95%CI 1.02-3.16), and endo-tidal CO2 > 50mmHg (OR 1.32; 95%CI 1.08-1.62)were identified as independent factors of SCE. Regarding the extubation failure due to SCE, age (OR 5.84; 95%CI 1.27-26.8) and maximum intraabdominal pressure with CO2 (OR 21.7; 95%CI 4.76-99.3) were identified as risk factors. Although the presence of SCE is associated with a low risk of severe complications, monitoring of the perioperative intraabdominal pressure is essential for performing safe laparoscopic/robotic surgery, particularly in elderly patients.

American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation.

This Clinical Practice Guideline (CPG) addresses the topic of acute fluid resuscitation during the first 48 hours following a burn injury for adults with burns ≥20% of the total body surface area (%TBSA). The listed authors formed an investigation panel and developed clinically relevant PICO (Population, Intervention, Comparator, Outcome) questions. A systematic literature search returned 5978 titles related to this topic and after 3 levels of screening, 24 studies met criteria to address the PICO questions and were critically reviewed. We recommend that clinicians consider the use of human albumin solution, especially in patients with larger burns, to lower resuscitation volumes and improve urine output. We recommend initiating resuscitation based on providing 2 mL/kg/% TBSA burn in order to reduce resuscitation fluid volumes. We recommend selective monitoring of intra-abdominal and intraocular pressure during burn shock resuscitation. We make a weak recommendation for clinicians to consider the use of computer decision support software to guide fluid titration and lower resuscitation fluid volumes. We do not recommend the use of transpulmonary thermodilution-derived variables to guide burn shock resuscitation. We are unable to make any recommendations on the use of high-dose vitamin C (ascorbic acid), fresh frozen plasma (FFP), early continuous renal replacement therapy, or vasopressors as adjuncts during acute burn shock resuscitation. Mortality is an important outcome in burn shock resuscitation, but it was not formally included as a PICO outcome because the available scientific literature is missing studies of sufficient population size and quality to allow us to confidently make recommendations related to the outcome of survival at this time.

Evaluation of the TraumaGuard Balloon-in-Balloon Catheter Design for Intra-Abdominal Pressure Monitoring: Insights from Pig and Human Cadaver Studies.

Introduction: Intra-abdominal pressure (IAP) monitoring is crucial for the detection and prevention of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In the 1970s, air-filled catheters (AFCs) for urodynamic studies were introduced as a solution to overcome the limitations of water-perfused catheters. Recent studies have shown that for correct IAP measurement with traditional AFC, the bladder needs to be primed with 25 mL of saline solution to allow pressure wave transmission to the transducer outside of the body, which limits continuous IAP monitoring. Methods: In this study, a novel triple balloon, air-filled TraumaGuard (TG) catheter system from Sentinel Medical Technologies (Jacksonville, FL, USA) with a unique balloon-in-balloon design was evaluated in a porcine and cadaver model of IAH via laparoscopy (IAPgold). Results: In total, 27 and 86 paired IAP measurements were performed in two pigs and one human cadaver, respectively. The mean IAPTG was 20.7 ± 10.7 mmHg compared to IAPgold of 20.3 ± 10.3 mmHg in the porcine study. In the cadaver investigation, the mean IAPTG was 15.6 ± 10.8 mmHg compared to IAPgold of 14.4 ± 10.4 mmHg. The correlation, concordance, bias, precision, limits of agreement, and percentage error were all in accordance with the WSACS (Abdominal Compartment Society) recommendations and guidelines for research. Conclusions: These findings support the use of the TG catheter for continuous IAP monitoring, providing early detection of elevated IAP, thus enabling the potential for prevention of IAH and ACS. Confirmation studies with the TraumaGuard system in critically ill patients are warranted to further validate these findings.

In Vitro Validation of a Novel Continuous Intra-Abdominal Pressure Measurement System (TraumaGuard).

Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson's and Lin's correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and -0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30% to60% and ACS in 15% to30% of all AP patients and they are markers of severe disease with high morbidity and mortality. The detrimental effect of increased IAP has been recognized in several organ systems, including the central nervous system, cardiovascular, respiratory, renal and gastrointestinal systems. The pathophysiologyof IAH/ACS developmentin patients with AP is multifactorial. Pathogenetic mechanisms include over-zealous fluid management, visceral edema, ileus, peripancreatic fluid collections, ascites and retroperitoneal edema. Laboratory and imaging markers are neither sensitive nor specific enough to detect IAH/ACS and intra-abdominal pressure (IAP) monitoring is vital for early diagnosis and themanagement of patients of AP with IAH/ACS. The treatment of IAH/ACS requires a multi-modality approach with both medical and surgical attention. Medical management consists of nasogastric/rectal decompression, prokinetics, fluid management and diuretics or hemodialysis. If conservative management is not effective, percutaneous drainage of fluid collection or ascites is necessary. Despite medical management, if IAP worsens, surgical decompression is warranted. The review discusses the relevance of IAH/ACS in patients of AP and its management.

Predictive value of diaphragm thickening fraction and intra-abdominal pressure monitoring-oriented risk prediction model for weaning failure in patients with severe acute pancreatitis

To establish a risk prediction model dominated by diaphragm thickening fraction (DTF) and intra-abdominal pressure (IAP) monitoring, and to explore the predictive value of the model for weaning failure in patients with severe acute pancreatitis (SAP). A prospective research was conducted. Sixty-three patients undergoing invasive mechanical ventilation treatment who diagnosed with SAP admitted to intensive care unit of the First Affiliated Hospital of Jinzhou Medical University from August 2020 to October 2021 were enrolled. The spontaneous breathing trial (SBT) was carried out when the clinical weaning criteria was met. The stable cardiovascular status, good pulmonary function, no chest and abdominal contradictory movement, and adequate oxygenation were defined as successful weaning. Otherwise, it was defined as failure weaning. The clinical indicators such as SBT 30-minure DTF, IAP, tidal volume (VT), respiratory rate (RR), body mass index (BMI), and blood lactic acid (Lac) were compared between the weaning success group and the weaning failure group. The indicators with statistically significant differences in the single-factor analysis were included in the secondary multivariable Logistic regression analysis to establish a risk prediction model. The correlation between the DTF and IAP at 30 minutes of SBT was analyzed. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT. Finally, 63 patients with SAP were enrolled. Among the 63 patients, 42 were successfully weaned and 21 failed. There were no significant differences in age, gender, and oxygenation index (PaO2/FiO2), sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score at admission between the two groups, indicating that the data in the two groups were comparable. Compared with the weaning success group, IAP, RR, BMI and Lac at 30 minutes of SBT in the weaning failure group were significantly increased [IAP (mmHg, 1 mmHg ≈ 0.133 kPa): 14.05±3.79 vs. 12.12±3.36, RR (times/min): 25.43±8.10 vs. 22.02±5.05, BMI (kg/m2): 23.71±2.80 vs. 21.74±3.79, Lac (mmol/L): 5.27±1.69 vs. 4.55±1.09, all P < 0.05], while DTF and VT were significantly decreased [DTF: (29.76±3.45)% vs. (31.86±3.67)%, VT (mL): 379.00±98.74 vs. 413.60±33.68, both P < 0.05]. Secondary multivariable Logistic regression analysis showed that DTF [odds ratio (OR) = 0.758, 95% confidence interval (95%CI) was 0.584-0.983, P = 0.037], IAP (OR = 1.276, 95%CI was 1.025-1.582, P = 0.029), and RR (OR = 1.145, 95%CI was 1.014-1.294, P = 0.029) were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The above risk factors were used to establish the risk prediction model of aircraft withdrawal failure at 30 minutes of SBT: Logit P = -0.237-0.277×DTF+0.242×IAP+0.136×RR. Pearson correlation analysis showed that SBT 30-minute DTF was significantly correlated with IAP in SAP patients, and showed a significant positive correlation (r = 0.313, P = 0.012). The ROC curve analysis results showed that area under the ROC curve (AUC) of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT was 0.716, 95%CI was 0.559-0.873, P = 0.003, with the sensitivity of 85.7% and the specificity of 78.6%. DTF, IAP and RR were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The DTF and IAP monitoring-oriented risk prediction model based on the above three variables has a good predictive value for weaning failure in patients with SAP.

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

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. 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. 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%. 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.

A Retrospective, Observational Study of Catheter-Associated Urinary Tract Infection Events Post-Implementation of a Novel Urinary Catheter System with Active Drain Line Clearance and Automated Intra-Abdominal Pressure Monitoring.

A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). Eight-year retrospective before and after study (2015-2022). A single American Burn Association-verified Burn Center with 14 inpatient beds. Patients meeting criteria for admission to a Burn Center. Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015-December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Patients were transferred from outside hospitals with gravity bladder. A distinction in the chart between catheter types was impossible. Charts were reviewed to characterize patients with CAUTI events. A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (p &lt; 0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.

Perioperative intra-abdominal pressure parameters for different surgical techniques in patients with ventral hernias

Aim. To study perioperative IAP parameters with various methods of hernioplasty in patients with ventral hernias.Materials and research methods. The results of the treatment of 148 patients with ventral hernias were studied. The first group included 58 patients for whom an anterior separation plasty was used for hernioplasty. The second group included 44 patients who underwent posterior separation of the abdominal wall muscles. The third group consisted of 46 patients who underwent onlay (n=28) and sublay (n=18) methods of hernioplasty.Results and discussion. In patients with W3 hernias, when closing the edges of the hernia orifice, there was a significant increase in IAP to a level corresponding to the I degree of intra-abdominal hypertension, which averaged 12.8±1.9 mm Hg (p&lt;0.05). In patients with W4 hernias, the level of intra-abdominal pressure after closing the edges of the hernia orifice was significantly higher than in patients with W3 hernias, and on average they were 14.7±1.7 mm Hg. (p&lt;0.05), which corresponded to the upper limit of the I degree of intra-abdominal pressure.Conclusion. The results of perioperative monitoring of intra-abdominal pressure indicate the tension nature of onlay and sublay hernioplasty methods, and therefore their use in hernias of W3 and W4 sizes is contraindicated. For large and giant hernias, the use of separation methods of hernioplasty is recommended.

Monitoring intra-abdominal pressure for early detection of preeclampsia among pregnant women

Background: Elevated intra-abdominal pressure (IAP) is commonly present in critically ill patients. Where the trigger mechanism of preeclampsia is related to increase abdominal hypertension. Aim: Monitoring the intra-abdominal pressure for early detection of preeclampsia among pregnant women. Design: A quasi-experiment clinical practice research. Methods: a sample of 60 pregnant women divided into an intervention group included a total of 30 patients diagnosed with preeclampsia and 30 normotensives as a control group. Setting: The study conducted at obstetric ICU and emergency unit, woman's Health Hospital, Upper Egypt. Results: There is a statistically significant difference between intra-abdominal pressure and preeclampsia and its clinical feature. The risk factors' effects on intra-abdominal pressure, such as age and gravidity, have no statistically significant relationship. Conclusions: The study confirms that the range of intra-abdominal pressure in the preeclamptic group significantly higher than the normotensive group, and there is a positive correlation between elevated IAP and preeclamptic complications. Relevance to clinical practice: Applied continuous nursing monitoring of intra-abdominal pressure for all critical patients in the obstetric field is an essential part of nursing care to avoid abdominal compartment syndrome and organ complications.

Intra-Abdominal Pressure Monitoring in Acute Severe Pancreatitis—A Boon or Bane?

Background Intra-abdominal hypertension (IAH) is increasingly reported in patients with acute pancreatitis, and is caused by visceral edema, massive fluid resuscitation, paralytic ileus, and retroperitoneal inflammation. Patients with acute severe pancreatitis actually suffer from abdominal compartment syndrome (ACS)/IAH and since there is a strong correlation between early organ dysfunction and mortality in these patients, IAH appears to be an active and attractive target for early analysis and intervention.[1] Aim The study is undertaken to estimate the significance of intra-abdominal pressure monitoring in acute severe pancreatitis. Objectives The objective of this study is to evaluate relationship between intra-abdominal pressure (IAP) and severity of acute pancreatitis and measure outcome in the form of intensive care unit (ICU) stay, hospital stay, treatment modality, and condition on discharge. Methodology A total of 50 patients diagnosed as acute severe pancreatitis were enrolled in this observational study. IAP monitoring was started on admission, once after controlling pain and then every 4 hours. IAP was measured via transvesical route. Data were collected on the length of the hospital stay, the development of systemic inflammatory response syndrome (SIRS), multiorgan failure, the extent of necrosis, the presence of infection, and mortality. Results IAH was present in 86% of patients with acute severe pancreatitis, which shows IAP monitoring is essential in managing these patients. Severity estimation by IAP monitoring is consistent with alternative laboratory parameters like Ranson’s score (p = 0.002), SIRS (p = 0.013), organ failure/multiple organ dysfunction syndrome (p = 0.009). Two deaths were incurred during the study period. Conclusions IAP measurement in acute severe pancreatitis is a cost-effective and prognostic marker. Timely diagnosis and management of IAH/ACS through IAP monitoring can prevent major comorbidity (ICU/hospital stay) and mortality.

Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent ‘spot-check’ manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH—which normally would remain undetected using traditional intermittent monitoring methods.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis

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). 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. 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 (×109/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 (cmH2O, 1 cmH2O ≈ 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). 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.

Preliminary study of reliability of transcutaneous sensors in measuring intraabdominal pressure

Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.

Intra-abdominal Pressure as a Prognostic Factor in Severe Acute Pancreatitis

Abstract Objective:To assess the prognostic value of Intra-abdominal Pressure in severe acute pancreatitis, compare it to APACHE II, to determine when to intervene based on intra abdominal pressure. Materials and Methods:We studied the role of intra-abdominal pressure measurement as a prognostic index and its applicability to determine the timing of intervention in cases of severe acute pancreatitis as a prospective cohort study from 2010- 2012, at Kamineni Hospital, L.B Nagar, Hyderabad. All patients who were admitted with severe acute pancreatitis and consented to take part in the study were enrolled. All patients were evaluated clinically, radiologically, biochemically and by the prognostic indices – APACHE II, Ranson criteria and intra-abdominal pressure measurement. A total of 55 patients were enrolled in this study. Intra-abdominal pressure was measured by intravesical technique using a Foley catheter.Intra-abdominal pressure was measured every 12 hours. Within 24 hours of admission, APACHE II score was obtained. Multivariate analysis was utilised for statistics. Results:Males comprised 73% of study population. Mean age was 41.23± 13.74 years (17- 83 years). Ten patients (18.81%) died. Among the non-survivors, the intra-abdominal pressure (20.1± 3.1073 Vs 8.97± 4.39) and the APACHE II (17.5 ±4.09 Vs3.93 ±4.345),were significantly greater, P value &lt;0.0001. The AUC for intra-abdominal pressureat 24 hours and at 72 hours was &gt;0.7, which is highly significant. The sensitivity for intra-abdominal pressure(&gt;13 mm Hg) at 72 hours as a marker for mortality was 100%. Conclusion:The Intra-abdominal pressure monitoring is rapid, reproducible, inexpensive and minimally invasive, and can be used as a marker of the severity and prognosis of severe acute pancreatitis. Intra-abdominal pressure could potentially be used to guide the timing of intervention. Compared to APACHE II, which is inclusive of multiple parameters, intra-abdominal pressure can serve the same purpose as a single prognostic index. Further, we recommend a large, multicentric studies to conclusively establish the predictive power of intra-abdominal pressure in acute pancreatitis and whether interventions known to reduce intra-abdominal pressure, can alter the ultimate outcome.

MO1003: Role of Tacrolimus Trough Levels on Intra-Abdominal Pressure After Kidney Transplantation

Abstract BACKGROUND AND AIMS Increased intra-abdominal pressure (IAP) is common after kidney transplantation (KT). However, the role of potential transplant-specific predictors of this complication, such as tacrolimus-associated endothelial dysfunction, remains unclear. We aimed to describe the relationship between tacrolimus trough levels and IAP in a sample of incident KT patients. METHOD Single-centre prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy were the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72 h after surgery or until reoperation. Mean IAP values during the first 7 2h (72 h-IAP) were used in this analysis. The first measured tacrolimus trough levels after transplantation were included as a potential predictor of IAP. Patients without recorded tacrolimus trough levels during the first 7 days after surgery were excluded. The study was approved by the local ethics committee. RESULTS A total of 192 patients were enrolled in the study. Table 1A summarizes relevant patient and haemodynamic variables. Subjects with more severe intra-abdominal hypertension were more commonly males, with longer dialysis vintage, higher BMI and suffered diabetes more frequently. Multivariate linear regression analysis was used to examine potential predictors of 72 h-IAP, including male sex, months on dialysis, body mass index (BMI) (Table 1B), 72 h-fluid balance and tacrolimus trough levels. Recipient age, months on dialysis, BMI and tacrolimus trough levels were independent predictors of 72 h-IAP. CONCLUSION Tacrolimus-associated endothelial dysfunction may play a role in the increase of IAP after transplantation. In contrast, accumulated fluid balance, one of the strongest predictors of IAP in the ICU setting, failed to predict IAP values in our sample. These results offer new insight both into the pathophysiology of increased IAP and into the complex mechanisms of tacrolimus-associated nephrotoxicity in the early post-transplant period.

Application Effect of Intra-Abdominal Pressure Monitoring System in Early Enteral Nutrition Nursing of ICU Patients.

In order to study and explore the application effect of intra-abdominal pressure monitoring in guiding ICU patients to implement early enteral nutrition therapy, we selected patients admitted to the emergency department of a hospital and classified them into groups A (n = 105) and B (n = 98). Among them, the A group gave early enteral nutrition treatment by monitoring the residual gastric mass, and the B group gave early enteral nutrition treatment by monitoring the stomach. It has been established that, compared to gastric residue monitoring, intra-abdominal pressure monitoring in ICU patients with early enteral nutrition therapy has an obvious advantage, it helps to improve the prognosis of patients, and intra-abdominal pressure combined with gastric residual monitoring scheme can effectively reduce the early enteral nutrition in the ICU patients, the incidence of abdominal distension, vomiting, and make it reach the goal as soon as possible. Early enteral nutrition in patients with increased tolerance is of great significance.