Document Detail


Can the abdominal perimeter be used as an accurate estimation of intra-abdominal pressure?
MedLine Citation:
PMID:  19050639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient's underlying physiologic status. Correct IAP measurement, therefore, is crucial. Most of the direct and indirect techniques are not free from risks and require some time and skills. This study looks at the possibility of using the abdominal perimeter (AP) as a quick estimation for IAP. METHODS: In total, 237 paired measurements were performed in 26 intensive care unit patients. The IAP was measured according to the recommendations of the World Society on Abdominal Compartment Syndrome via an indwelling bladder catheter using a pressure transducer. The AP was defined as the abdominal circumference at its largest point using body marks as reference for consecutive measurements. RESULTS: The male:female ratio was 1:1, age 69.8 +/- 15.2 yrs, Acute Physiology and Chronic Health Evaluation II score 26.5 +/- 9.2, and Simplified Acute Physiology Score II score 58 +/- 15.5. The number of measurements in each patient was 9.4 +/- 4.6. The IAP was 10.8 +/- 4.9 mm Hg, and the AP was 101 +/- 19.2 cm. There was a poor but statistically significant correlation between IAP and AP: AP = 1.8 x IAP + 81.6 (R2 = 0.21, p = 0.04), but the bias was considerable. The correlation was somewhat better between DeltaIAP (the difference between two consecutive IAP measurements) and DeltaAP (the difference between two consecutive AP measurements) in 210 paired measurements: DeltaAP = 0.4 x DeltaIAP + 0.1 (R2 = 0.24, p < 0.0001). The analysis according to Bland and Altman showed that DeltaIAP was almost identical to DeltaAP with a mean difference or bias of 0 +/- 3 (95% confidence interval: -0.4 to 0.4); however, the limits of agreement were large and thus reflect poor agreement. CONCLUSIONS: In view of the poor correlation between IAP and AP, the latter cannot be used as a clinical estimate for IAP. The correlation between DeltaIAP and DeltaAP was somewhat better, meaning that DeltaAP can be used as an estimate of the evolution of IAP over time; however, for making a definite diagnosis of intra-abdominal hypertension or abdominal compartment syndrome, the exact value of IAP needs to be measured.
Authors:
Manu L N G Malbrain; Inneke De laet; Niels Van Regenmortel; Karen Schoonheydt; Hilde Dits
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-31     Completed Date:  2009-02-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  316-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Intensive Care Medicine, ZiekenhuisNetwerk Antwerpen, Campus Stuivenberg, Antwerpen, Belgium. manu.malbrain@skynet.be
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MeSH Terms
Descriptor/Qualifier:
Abdomen / anatomy & histology*
Aged
Anthropometry*
Compartment Syndromes / diagnosis*
Critical Illness
Female
Humans
Male
Pressure
Prospective Studies
Reproducibility of Results
Comments/Corrections
Comment In:
Crit Care Med. 2009 Jan;37(1):373-4   [PMID:  19112315 ]

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