Intra-abdominal Pressure Measurement Research Articles

Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs

Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28-42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.

Management of intra-abdominal hypertension and abdominal compartment syndrome: a review

Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function.

Expanded Measurements of Intra-Abdominal Pressure Do Not Increase the Detection Rate of Intra-Abdominal Hypertension

Intra-abdominal hypertension may contribute to a poor outcome. Whether limiting intra-abdominal pressure measurements to preselected at-risk patients allows for sufficient detection of intra-abdominal hypertension is unclear. We aimed to clarify whether expanded intra-abdominal pressure monitoring results in an increased detection rate of intra-abdominal hypertension. Retrospective observational study. General ICU of University Hospital. Consecutive adult ICU patients from 2004 to 2011. Intra-abdominal pressure measurements in predefined at-risk patients. Prospectively collected data of 2,696 admissions were divided into three subgroups according to the intra-abdominal pressure measurement policy in different years: 1) 2004-2005, mechanically ventilated patients with at least one additional risk factor for intra-abdominal hypertension (multiple trauma, abdominal surgery, pancreatitis, post-cardiopulmonary resuscitation, fluid resuscitation > 5 L/24 hr, vasoactive or inotropic support, and renal replacement therapy); 2) 2006-2009, all mechanically ventilated patients expected to stay for more than or equal to 24 hours; and 3) 2010-2011, mechanically ventilated patients with a body mass index greater than 30 kg/m, positive end-expiratory pressure more than 10 cm H2O, PaO2/FIO2 less than 300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding, or postlaparotomy. In all, 2,696 patients were studied, and 1,241 patients (46.0%) underwent intra-abdominal pressure monitoring. The intra-abdominal pressure was measured in 31.7%, 55.6%, and 41.1% of patients during the first, second, and third time periods (p < 0.001), and intra-abdominal hypertension (intra-abdominal pressure ≥ 12 mm Hg) occurred in 19.9%, 20.3%, and 20.1% of patients, respectively (p = 0.972). The mean intra-abdominal pressure at admission day was an independent predictor of mortality in patients with intra-abdominal pressure measurements started within the first 24 hours (odds ratio, 1.046 [95% CI, 1.019-1.072]). The mortality of patients with intra-abdominal hypertension was 29.8% versus 18.6% in those without intra-abdominal hypertension (p < 0.001). Expanding the measurement of intra-abdominal pressure to more than 50% of intensive care admissions does not increase the detection rate of intra-abdominal hypertension. In patients with intra-abdominal pressure monitoring, the mean intra-abdominal pressure on the admission day is an independent predictor of mortality.

Abdominal compartment syndrome

Despite being a recognized clinical entity for past more than 100 years, Abdominal Compartment Syndrome (ACS) continues to be an ill understood and under diagnosed condition in surgical practice. It has a high prevalence of upto 50 percent in general surgical or trauma patients receiving intensive care and is associated with twice the death rate. Concurrent medical conditions such as diabetes, ascites, heart failure and a host of others increase the vulnerability both in terms of development of ACS and a poorer outcome. It is also a major cause of death in trauma. Since ACS often clinically mimics the underlying condition, such as abdominal injury or peritonitis/ ascites from any cause, its presentation is confusing. Diagnosis is based on clinical awareness of its potential risk, simple bedside intra-abdominal pressure (IAP) measurement, repeated examination of the abdomen and a 24 × 7 vigil on vital signs. Biochemical markers are non-specific and unreliable. Treatment is very urgent and may involve achieving permissive hypotension, careful management of fluid balance, high quality intensive medical and nursing care, prevention/treatment of sepsis, abdominal drainage and if indicated, decompression surgery by laparotomy, leaving the abdomen open and protected with sterile dressings or a temporary abdominal negative pressure therapy device. Prompt, good and urgent care reduces the risk of adverse outcome.

Hipertensión intraabdominal: consecuencias sobre la circulación esplácnica. Estudio preliminar en un modelo de ascitis

IntroductionIntra-abdominal hypertension is defined as a rise in intra-abdominal pressure leading to progressive dysfunction of the abdominal organs. ObjectiveTo evaluate the effects of intra-abdominal hypertension on the splanchnic circulation in a porcine animal model with a view to determining the diagnostic method of choice. Material and methodsA total of 10 swine were divided into 2 groups: a control group and a group with an ascites pressure of 20mmHg. Transvesical and transperitoneal intra-abdominal pressures were registered, and the correlation between the measurements obtained was determined. Concentrations of lactic acid, alanine aminotransferase, glucose and gastric mucosal pH were also obtained. We registered the mean arterial and abdominal perfusion pressures, and the correlation of the latter with gastric mucosal pH and lactic acid concentrations. The parameters were registered for a total of 3hours. ResultsWe observed a high correlation between transvesical and transperitoneal measurements of intra-abdominal pressure (R2=0.98). In the 20mmHg pressure group, lactic acid concentrations increased significantly at 180min (p<0.011). Gastric mucosal pH differed significantly between the 2 groups from the beginning of the study (p=0.004) and significantly decreased from 120min onward. Mean arterial and abdominal perfusion pressures gradually decreased during the trial, with early significant changes in the abdominal perfusion pressure (p=0.001), and a good correlation with the remaining study parameters. There were no significant changes in hepatic indicators. ConclusionsWe believe the transvesical approach to be the technique of choice to determine intra-abdominal pressure. Abdominal perfusion pressure is a sensitive marker of intra-abdominal hypertension, and gastric mucosal pH is the first parameter to be affected.

Are Standard Intra-Abdominal Pressure Values Different during Pregnancy?

BackgroundMeasurement of intra-abdominal pressure (IAP) is an important parameter in the surveillance of intensive care unit patients. Standard values of IAP during pregnancy have not been well defined. The aim of this study was to assess IAP values in pregnant women before and after cesarean delivery.MethodsThis prospective study, carried out from January to December 2011 in a French tertiary care centre, included women with an uneventful pregnancy undergoing elective cesarean delivery at term. IAP was measured through a Foley catheter inserted in the bladder under spinal anaesthesia before cesarean delivery, and every 30 minutes during the first two hours in the immediate postoperative period.ResultsThe study included 70 women. Mean IAP before cesarean delivery was 14.2 mmHg (95%CI: 6.3–23). This value was significantly higher than in the postoperative period: 11.5 mmHg (95%CI: 5–19.7) for the first measurement (p = 0.002). IAP did not significantly change during the following two postoperative hours (p = 0.2). Obese patients (n = 25) had a preoperative IAP value significantly higher than non-obese patients: 15.7 vs. 12.4; p = 0.02.ConclusionIn term pregnancies, IAP values are significantly higher before delivery than in the post-partum period, where IAP values remain elevated for at least two hours at the level of postoperative classical abdominal surgery. The knowledge of these physiological changes in IAP values may help prevent organ dysfunction/failure when abdominal compartment syndrome occurs after cesarean delivery.

MINILAPAROTOMIC TECHNOLOGIES IN DIAGNOSIS AND TREATMENT OF POSTOPERATIVE INTRA-ABDOMINAL COMPLICATIONS

Aim. To improve the results of surgical treatment of intra-abdominal postoperative complications at the expense of differentiated use of minilaparotomic and endovideosurgical technologies. Materials and methods. Treatment of 617 patients who underwent repeated operative interventions on abdominal organs in connection with different early postoperative intra-abdominal complications were analyzed. Mini-invasive repeated medicodiagnostic operative interventions were performed in 268 (56,4%) cases for acute destructive pancreatitis and its complications, in 65 (13,7%) cases – regarding postoperative biliary complications, in 37 (7,8%) – postoperative appendectomy complications, 31 (6,1%) – postoperative stomach and bowel complications. For the purpose of making prognosis of early postoperative intra-abdominal complications and diagnosis of intra-abdominal hypertensive syndrome, 95 patients underwent indirect measurement of intra-abdominal pressure. Results. Intra-abdominal pressure monitoring with determination of the degree of intra-abdominal hypertension was the basic factor for choosing the tactics of further surgery. The developed algorithm of surgical tactics permitted to decrease the number of relaparotomies to 142 (23%).

EComment. A significance of intra-abdominal pressure in cardiovascular patients

Intra-abdominal hypertension (IAH) is a lethal yet under-appreciated complication of cardiovascular surgery. Dalfino et al. [1] stated that the baseline value of intra-abdominal pressure (IAP) may be an early warning parameter for IAH occurrence. To investigate this statement, last year, we conducted a study in which we assessed correlations among the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including the systemic inflammatory response syndrome (SIRS), multiple organ dysfunction score (MODS) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients after open surgical repair of abdominal aneurysms. The IAP was measured in a non-invasive manner via the urinary bladder filled up with 100 ml saline solution, through the previously drained and clamped standard urinary catheter [2]. The actual pressure was transmitted to a manometer into the mid-axillary line. A pressure above 15 mmHg is considered elevated [3]. Of 50 studied patients with a survival rate of 50%, we found IAP values over 15 mmHg in 26 patients (52%). The non-parametric statistical Kruskal-Wallis test was used for comparison of survivors and non-survivors distribution of IAP values. The median for non-survivors was 18 (range 6-30), and for survivors the median was 15 (range 6-36) with significance P < 0.009. The same statistic was applied for MODS values where the median for non-survivors was 3 (range 0-6), and for survivors 1 (range 0-3), P < 0.0072. For the APACHE II score the non-survivors median was 18 (range 0-34), and survivors 9 (range 2-23), P < 0.0067. We did not find any significance in relation to the IAP values and disease severity scores in linear regression statistics. On the other hand, the linear regression correlation demonstrated the comparison of APP with disease severity scores as follows: a) APP versus SIRS-correlation coefficient (r = -0.43, P < 0.05); b) APP versus MODS (r = -0.49, P < 0.05); c) APP versus APACHE II (r = -0.47, P < 0.05). According to our results, we conclude that the measurement of IAP might have a predictive value in cardiovascular surgical patient's survival rates, but the APP may be a better indicator of IAH severity. Measurement of IAP is widely accepted, inexpensive and a simple monitoring tool for IAH [4]. However, it is an intermittent measurement and therefore not always appropriate as an indicator for the organ dysfunction that typifies IAH. The other problem with IAP is that it is an indicator of the syndrome (defined by IAP as abdominal compartment syndrome), not a real predictor: when IAP is pathologically elevated and organ dysfunctions are imminent, prevention of the syndrome is a faint hope. Authors stated that their findings encourage further studies to define the role of continuous IAP monitoring and therapeutic strategies. According to the results presented by Dalfino et al., which support our results we could conclude that further investigations of the predictors of IAH in cardiovascular patients must include both physiological measurements and resuscitative interventions. Conflict of interest: none declared

Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome

PurposeTo update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).MethodsWe conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear).ResultsIn addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.ConclusionAlthough IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-013-2906-z) contains supplementary material, which is available to authorized users.

Renal consequences of intraabdominal hypertension in a porcine model. Search for the choice indirect technique for intraabdominal pressure measurement

ObjectiveTo study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure. Materials and methods30 pigs were used and divided into two groups according to increased intraabdominal pressure values (20mm Hg and 30mm Hg). In both groups pressures were registered 8 times, summing up to 3h, with a CO2 insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomach a catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine. ResultsThere was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R2=0.95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30mm Hg (p<0.020). Urine production was lower at 30mm Hg compared with the 20mm Hg group (9.63±1.57ml versus 3.26±1.73ml). Serum creatinine increased in both groups being pathological at 30mm Hg after 1h 20min, with existing differences between early pressures (p<0.027). ConclusionsThis study revealed marked renal affectation with higher severity at 30mm Hg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure.

Evaluation of Intra‐Abdominal Pressure in Horses That Crib

To measure intra-abdominal pressure (IAP) in horses that crib and compare it with IAP in horses that do not have this vice. Cohort study. Healthy cribbing horses (cribbing cohort, n = 8) and 8 healthy noncribbing horses (noncribbing cohort). A microsensor catheter was introduced into the peritoneal cavity through the right paralumbar fossa, using local anesthesia, for measurement of IAP. These pressures were recorded in 1-minute intervals for 2 hours, while the horses were standing tied in a stall. IAPs of cribbing horses were compared to the noncribbing cohort. Baseline IAPs were not significantly different between cribbing and noncribbing cohorts (P = .076); however, IAPs in the cribbing cohort were significantly increased when compared with the noncribbing cohort, during active cribbing behavior (P = .0016). Frequency of cribbing was not associated with increased IAP (P = .35). IAPs in the cribbing cohort remained significantly elevated compared with the noncribbing cohort, even after the behavior had ceased (P = .0002). Cribbing is associated with increased IAP in the horse, both during and after the behavior.

Direct Measurement of Intra-abdominal Pressures in a Horse by Using a Solid Microsensor

Current techniques to measure intra-abdominal pressures in horses use metal cannulas. Concerns that the metal cannula could puncture abdominal viscera if left in place prevent continual pressure measurements. The aim of this study was to validate the use of a solid microsensor and digital monitoring system in the measurement of direct intra-abdominal pressure in horses by comparing its values with the ones simultaneously obtained by means of an intraperitoneal cannula. Ten healthy adult horses had intra-abdominal pressures measured simultaneously through an intraperitoneal cannula zeroed midway between the height of the tuber ishii and point of the shoulder and by the use of an intraperitoneal solid microsensor placed within the abdomen at the same level as the metal cannula. Three repeated intra-abdominal pressure measurements were obtained at rest, after placement of a nasogastric tube, and after placement of 5-L increments of water into the stomach, up to a total volume of 20 L of water. The difference between values obtained (after conversion) was 3.6 mm Hg. The correlation coefficient was 0.825. Direct intra-abdominal pressure monitoring with a solid microsensor allows continuous monitoring without concern for gastrointestinal perforation, is simple to use and to calibrate, and is minimally invasive.

The Measurement of Intra-abdominal Pressure in Awake Rat Cystometry

The history of animal cystometry revolves around the desire for specification of the lower urinary tract functions as a dynamic reservoir. However, in animal models, the functional significance of intra-abdominal pressure (IAP) in urodynamics have not been well-studied. The measurement of IAP and its interpretation are essential for evaluating the bladder functions. In addition, the IAP is a key physiological parameter in an animal experimental model of voiding dysfunction. In this issue of International Neurourology Journal, Lee and Yoon [1] provides an overview of the significance of the IAP in an awake-animal cystometry. There are two key roles of the IAP in an awake-animal cystometry model as shown below:

Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients

Introduction:An increase in abdominal pressure can lead to so-called intra–abdominal compartment syndrome (ACS). Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP) through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients.Materials and Methods:This research was a descriptive–analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software.Results:The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS (P < 0.001).Conclusions:According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma) is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.

The Role of Intra-abdominal Pressure Measurement in Awake Rat Cystometry

Rat cystometry is increasingly being used in research on overactive bladder and is a research tool for investigating bladder functions during the storage and voiding phases. Measurement of the pressure in the bladder is an essential part of cystometry, although that pressure is the sum of both detrusor and intra-abdominal pressures. In anesthetic cystometry, measurement of the intra-abdominal pressure is not necessary, because the values of this variable are negligible. In awake cystometry, however, it is mandatory to separate the changes in intra-abdominal pressure from those in intravesical pressure, because consciousness causes much variability in intra-abdominal pressure. This review describes why we use the term "detrusor overactivity" in animal research with intra-abdominal pressure and presents evidence for the role of intra-abdominal pressure in the cystometry of normal rats and in animal models of overactive bladder directed at understanding the pathogenesis of the overactive bladder condition. The methodology is also briefly reviewed.

Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair.

To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages. The IAP (measured via both techniques) increased on average by 12% during surgery compared to AI (P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube (P < 0.01). In parallel, the gradient between РаСО2 and EtCO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/FiO2 decreased by 30% one hour after tracheal extubation (P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20% (P < 0.025). At all stages, we observed a significant correlation between IGP and IBP (r = 0.65-0.81, P < 0.01) with a mean bias varying from -0.19 mmHg (2SD 7.25 mmHg) to -1.06 mm Hg (2SD 8.04 mmHg) depending on the study stage. Taking all paired measurements together (n = 133), the median IGP was 8.0 (5.5-11.0) mmHg and the median IBP was 8.8 (5.8-13.1) mmHg. The overall r (2) value (n = 30) was 0.76 (P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mmHg (2SD 4.2 mmHg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing ΔIBP and ΔIGP (n = 117). During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/FiO2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.

Fistules du dorsum nasal de l’enfant : à propos de six cas

This review will describe the definitions on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In order to understand these definitions the reader must be aware of the interactions between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV), explaining why dramatic IAP increases can be observed in some patients related to anthropomorphic measurements, body positioning, use of positive pressure ventilation, or relatively small accumulations of fluid or blood. The adverse effects related to increased IAP have been named IAH for moderate cases and ACS for advanced cases. In order to improve clinical communication as well as evaluation of the scientific literature, the World Society for the Abdominal Compartment Syndrome (WSACS) has published its first guidelines and definitions in 2006. The definitions and guidelines have recently been revised according to evidence based medicine and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review will be based on the revised guidelines. The standard method to measure IAP is via the bladder and as experience with IAP measurement has evolved considerably, a number of tips and potential pitfalls are listed.

Measurement of intra‐abdominal pressure in dogs and cats

To review and summarize the human and veterinary literature on intra-abdominal pressure measurement techniques. Human and veterinary clinical studies, research articles, reviews, and textbooks with no date restrictions with a focus on techniques for intra-abdominal pressure (IAP) measurement and their limitations. Human literature has established the intravesicular method as the gold standard for indirect measurement of IAP. However, current research has explored the intragastric method as a valid alternative. Recently, debate has focused on the shortcomings of the various measurement methods. Early human literature using dogs as models contributed to the original data for IAP measurements in small animals. Since that time, a number of clinical studies and 1 case report have contributed to that original information. A reference interval for IAP measured by the intravesicular method has recently been determined in healthy cats. Further studies investigating IAP in critically ill veterinary patients are required to establish the optimal technique for this measurement in veterinary medicine.

Intra-abdominal pressure measurement using the FoleyManometer does not increase the risk for urinary tract infection in critically ill patients.

ObjectiveThe aim of this study was to determine whether intra-abdominal pressure (IAP) monitoring using the FoleyManometer (Holtech Medical, Charlottenlund, Denmark) increases the risk of urinary tract infection (UTI).DesignA retrospective database review was conducted.SettingThe study was conducted in the 12-bed medical intensive care unit of ZNA Stuivenberg Hospital (Antwerp, Belgium), a tertiary hospital.PatientsThere were 5,890 patients admitted to the medical intensive care unit of which 1,097 patients underwent intrabladder pressure (IBP) monitoring as estimate for IAP.InterventionsCrude and adjusted UTI rates were compared among patients undergoing IAP measurements with three different intrabladder methods: a modified homemade technique, a FoleyManometer with 35 ml reservoir, and a FoleyManometer low volume (FoleyManometerLV) with less than 10 ml priming volume.Measurements and resultsFour consecutive time periods of 24 months were defined and compared with regard to IAP measurement: period 1 (2000-2001), during which IAP monitoring was not used routinely (which serves as a control group), was compared with period 2 (2002-2003), using a modified homemade technique; period 3 (2004-2005), introducing the FoleyManometer; and finally period 4 (2006-2007), in which the FoleyManometerLV was introduced. The incidence of IBP measurements increased from 1.4% in period 1 to 45.4% in period 4 (p < 0.001). At the same time, the Simplified Acute Physiology Score (version 2) (SAPS-II) increased significantly from 24.4 ± 21.5 to 34.9 ± 18.7 (p < 0.001) together with the percentage of ventilated patients from 18.6% to 40.7% (p < 0.001). In total, 1,097 patients had IAP measurements via the bladder. The UTI rates were adjusted for disease severity by multiplying each crude rate with the ratio of control versus study patient SAPS-II probability of mortality. Crude and adjusted UTI rates per 1,000 catheter days (CD) were on average 16.1 and 12.8/1,000 CD, respectively, and were not significantly different between the four time periods.ConclusionsIntrabladder pressure monitoring as estimate for IAP either via a closed transducer technique or the closed FoleyManometer technique seems safe and does not alter the risk of UTI in critically ill patients.

Effects of zero reference position on bladder pressure measurements: an observational study.

BackgroundAlthough the World Society for Abdominal Compartment Syndrome in its guidelines recommends midaxillary line (MAL) as zero reference level in intra-abdominal pressure (IAP) measurements in aiming at standardizing the technique, evidence supporting this suggestion is scarce. The aim of this study is to study if the zero reference position influences bladder pressure measurements as estimate for IAP.MethodsThe IAP of 100 surgical patients was measured during the first 24 h of admission to the surgical intensive care unit of General Calixto Garcia Hospital in Havana (Cuba) following laparotomy. The period was January 2009 to January 2010. The IAP was measured twice with a six-hour interval using the transurethral technique with a priming volume of 25 ml. IAP was first measured with the zero reference level placed at MAL (IAPMAL), followed by a second measurement at the level of the symphysis pubis (SP) after 3 minutes (IAPSP). Correlations were made between IAP and body mass index (BMI), type of surgery, gender, and age.ResultsMean IAPMAL was 8.5 ± 2.8 mmHg vs. IAPSP 6.5 ± 2.8 mmHg (p < 0.0001). The bias between measurements was 2.0 ± 1.5, 95% confidence interval of 1.4 to 3.0, upper limit of 4.9, lower limit of -0.9, and a percentage error of 35.1%. IAPMAL was consistently higher than IAPSP regardless of the type of surgery. The BMI correlated with IAP values regardless of the zero reference level (R2 = 0.4 and 0.3 with IAPMAL and IAPSP respectively, p < 0.0001).ConclusionsThe zero reference level has an important impact on IAP measurement in surgical patients after laparotomy and can potentially lead to over or underestimation. Further anthropometric studies are needed with regard to the relative MAL and SP zero reference position in relation to the theoretical ideal reference level at midpoint of the abdomen. Until better evidence is available, MAL remains the recommended zero reference position due to its best anatomical localization at iliac crest.