Comparing intra-abdominal pressures in different body positions via a urinary catheter and nasogastric tube: a pilot study

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• 作者：Nirooshan Rooban (1)
  Adrian Regli (1) (2)
  Wendy A Davis (3)
  Bart L De Keulenaer (1)
  
• 关键词：intra ; abdominal hypertension ; intra ; abdominal pressure ; abdominal compartment syndrome ; gastric pressure ; body position
• 刊名：Annals of Intensive Care
• 出版年：2012
• 出版时间：July 2012
• 年：2012
• 卷：2
• 期：1-supp
• 全文大小：187KB
• 参考文献：1. Malbrain MLNG, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre P-F, Gattinoni L: Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. / Intensive Care Med 2004, 30:822-29. CrossRef
  2. Malbrain MLNG, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre P-F, Frank G, de Souza P, Cesana B, Gattinoni L: Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. / Crit Care Med 2005, 33:315-22. CrossRef
  3. Cheatham ML, Malbrain MLNG, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. / Intensive Care Med 2007, 33:951-62. CrossRef
  4. Malbrain MLNG, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. / Intensive Care Med 2006, 32:1722-732. CrossRef
  5. Cheatham ML, Safcsak K: Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? / Crit Care Med 2010, 38:402-07. CrossRef
  6. Malbrain MLNG: Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. / Intensive Care Med 2004, 30:357-71. CrossRef
  7. Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, Muscedere J, Foster D, Mehta N, Hall R, Brun-Buisson C: Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. / Ann Intern Med 2004, 141:305-13.
  8. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R: Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. / MMWR Recomm Rep 2004, 53:1-6.
  9. Cheatham ML, De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, Cresswell AB, Malbrain M, Bodnar Z, Mejia-Mantilla JH, Reis R, Parr M, Schulze R, Puig S, World Society of the Abdominal Compartment Syndrome Clinical Trials Working Group: The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. / Crit Care Med 2009, 37:2187-190. CrossRef
  10. De Keulenaer BL, De Waele JJ, Powell B, Malbrain MLNG: What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? / Intensive Care Med 2009, 35:969-76. CrossRef
  11. Kron IL, Harman PK, Nolan SP: The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. / Ann Surg 1984, 199:28-0. CrossRef
  12. Malbrain ML, De laet I, Viaene D, Schoonheydt K, Dits H: In vitro validation of a novel method for continuous intra-abdominal pressure monitoring. / Intensive Care Med 2008, 34:740-45. CrossRef
  13. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. / Lancet 1986, 1:307-10. CrossRef
  14. De Waele JJ, Cheatham ML, Malbrain MLNG, Kirkpatrick AW, Sugrue M, Balogh Z, Ivatury R, De Keulenaer B, Kimball EJ: Recommendations for research from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. / Acta Clin Belg 2009, 64:203-09.
  15. Collee GG, Lomax DM, Ferguson C, Hanson GC: Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. / Intensive Care Med 1993, 19:478-80. CrossRef
  16. Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM: Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. / Intensive Care Med 1994, 20:588-90. CrossRef
  17. Turnbull D, Webber S, Hamnegard CH, Mills GH: Intra-abdominal pressure measurement: validation of intragastric pressure as a measure of intra-abdominal pressure. / Br J Anaesth 2007, 98:628-34. CrossRef
  18. De Waele JJ, Berrevoet F, Reyntjens K, Pletinckx P, De laet I, Hoste E: Semicontinuous intra-abdominal pressure measurement using an intragastric compliance catheter. / Intensive Care Med 2007, 33:1297-300. CrossRef
  19. De Potter TJ, Dits H, Malbrain ML: Intra- and interobserver variability during in vitro validation of two novel methods for intra-abdominal pressure monitoring. / Intensive Care Med 2005, 31:747-51. CrossRef
  20. Engum SA, Kogon B, Jensen E, Isch J, Balanoff C, Grosfeld JL: Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome. / J Pediatr Surg 2002, 37:214-18. CrossRef
  21. Schachtrupp A, Tons C, Fackeldey V, Hoer J, Reinges M, Schumpelick V: Evaluation of two novel methods for the direct and continuous measurement of the intra-abdominal pressure in a porcine model. / Intensive Care Med 2003, 29:1605-608. CrossRef
  22. Davis PJ, Koottayi S, Taylor A, Butt WW: Comparison of indirect methods of measuring intra-abdominal pressure in children. / Intensive Care Med 2005, 31:471-75. CrossRef
  23. Becker V, Schmid RM, Umgelter A: Comparison of a new device for the continuous intra-gastric measurement of intra-abdominal pressure (CiMon) with direct intra-peritoneal measurements in cirrhotic patients during paracentesis. / Intensive Care Med 2009, 35:948-52. CrossRef
  24. Malbrain ML, De Laet IE, Willems A, Van Regenmortel N, Schoonheydt K, Dits H: Localised abdominal compartment syndrome: bladder-over-gastric pressure ratio (B/G ratio) as a clue to diagnosis. / Acta Clin Belg 2010, 65:98-06.
  25. Collard JM, Romagnoli R: Human stomach has a recordable mechanical activity at a rate of about three cycles/minute. / Eur J Surg 2001, 167:188-94. CrossRef
  
• 作者单位：Nirooshan Rooban (1)
  Adrian Regli (1) (2)
  Wendy A Davis (3)
  Bart L De Keulenaer (1)
  
  1. Intensive Care Unit, Fremantle Hospital, 1 Alma Street, 6160, Fremantle, Western Australia, Australia
  2. Medical School, The University of Notre Dame, Fremantle, Western Australia, Australia
  3. School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Kragujevac, Western Australia, Australia
  

文摘

Objectives Intra-abdominal pressure (IAP) is most commonly measured via the bladder with the patient in the supine position. In the ICU, patients are nursed with the head of the bed elevated at 30° (HOB30) to reduce the risk of ventilator-associated pneumonia. This study investigated whether gastric pressure at HOB30 can be used as a surrogate measure of IAP via the bladder in the supine position. Methods A prospective observational study was conducted in a single-centre intensive care unit. A total of 20 patients were included. IAP was recorded simultaneously via the bladder catheter (bladder pressure, IBP) and via nasogastric tube (gastric pressures, IGP) in the supine and HOB30 position. Each patient had three sets of IAP measurements performed at least 4 h apart. Results In the supine position, mean IBP was 12.3 ± 4.5 mmHg compared to IGP of 11.8 ± 4.7 mmHg. The bias between the two groups was 0.5 and precision of 3.7 (LA, -6.8 to 7.5 mmHg). At 30 degrees, mean IBP was 15.8 ± 4.9 mmHg compared to IGP of 13.1 ± 6.1 mmHg. The bias between both groups was 2.7 with a precision of 5.5 (LA, -8.0 to 13.5). Comparing IBP in the supine position with IGP at 30° showed a bias of -0.8 and precision of 5.6 (LA, -10.1 to 11.6 mmHg). Conclusion IAP measured via a nasogastric tube was less influenced by changing the body position from supine to HOB30 than was bladder pressure.