We read with interest the article byBecker et al. [1] looking at the cor-relation between directintraabdominal pressure (IAP) andpressures in the stomach obtained viaa balloon-tipped catheter in tenpatients with cirrhosis. We agree thatthe CiMON system needs to be clin-ically validated. However, we feel theauthors misinterpret their data statingthat the CiMON device cannot beregarded as a reliable substitute forstandard IAP measurement tech-niques, for the simple reason that nogold standard IAP technique wasused. The sample size is small, andthere are issues about themethodology.First, the statistical linear regres-sion analysis used suffers from anessential misconception. On average,approximately nine repeated sets ofmeasurements were collected fromten patients, giving a total of 90paired measurements. This meansthat there were two sources of varia-tion that have to be distinguished: thebetween-patients variation and thewithin-patients variation. This paperdeals mainly with the second kind ofvariation in view of the small samplesize and the (high) number ofrepeated measurements. However,instead of analysing the within-patients variation, the data weretreated as if they came from onepatient. Although it is not sure thatthis was the case, this kind of analysismay produce erroneous results [2, 3].Second, the major drawback isthat no clinically acceptable goldstandard method for IAP measure-ment like bladder pressure was used.We don’t agree with the statementthat the gold standard in experimen-tal studies is direct monitoring ofintraperitoneal pressure. This mayhold true for animal research; how-ever, this is not in accordance withthe latest recommendations for clin-ical research [4–6].Third, the population under studyis not homogeneous since somepatients were mechanically venti-lated, while others were not, and thedemographics were only brieflydescribed. The patient sample wasprobably more convenient than a realcohort sample, which is not a fair wayto validate a new measurementmethod [7]. The evolution ofabdominal wall compliance (Cab)could have been calculated as shownin Table 1 and Fig. 1.Finally, although the authors cor-rectly state some limitations of theirstudy, they try to explain the observeddifferences by alluding to the relativeposition of the probes. This suggeststhey do not consider the abdomen tobe primarily fluid in character, hencenot following the laws of Pascal. Isthis the case? Decramer [8] reportedindeed that gastric pressure swings indogs were not simply hydrostatic.This study found the abdomen notbehaving as a hydraulic system orliquid-filled container. However, theIAP differences observed in the dogsdisappeared when the abdominalcavity was filled with 2 l of saline.9] measuredpressures in the abdomen next to theventral abdominal wall and within thestomach of anaesthetised dogs, andconcluded there were three factorsaffecting IAP: gravity, uniform com-pression and shear deformation. In1996, Tzelepis [10] re-established theconcept that the abdomen behaves asa hydraulic system. Based on theavailable data, we hypothesise theimpact of the above-mentioned threefactors on the measurement of IAP isprobably not significant in the fullysedated mechanically ventilatedpatient with sepsis, capillary leak anda positive fluid balance, with orwithout neuromuscular blockingagents [11]. Therefore, in situationsof large amounts of intraperitonealfluid (as was the case in the presentstudy), the abdomen does probablybehave as a hydraulic container, and