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Comparison of indirect methods of measuring intra-abdominal pressure in children

Abstract

Objective

To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children.

Design and setting

Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia.

Patients and participants

20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery.

Interventions

IAP was measured directly via the peritoneal dialysis catheter and by intragastric manometry via an indwelling nasogastric tube, and by intravesical manometry via an indwelling transurethral urinary catheter, using volumes of 0, 1, 3 and 5 ml/kg body weight of sterile saline instilled into the bladder.

Measurements and results

Across the range of IAPs of 1–8 mmHg the Bland-Altman method for assessing agreement between two methods of clinical measurement showed bladder pressure measured via the urinary catheter with 1 ml/kg body weight of saline instilled to be the most accurate indirect measurement technique, tending to give pressures between 0.07 and 1.23 mmHg higher than the direct measurement (95% CI for bias). Measuring bladder pressure with either no saline instilled or more saline per kilogram body weight instilled was less accurate over the same range of pressures, as was measuring the gastric pressure.

Conclusions

The most accurate indirect method of measuring IAP in children over the normal range of IAPs involves measuring bladder pressure via a transurethral urinary catheter with 1 ml/kg body weight of sterile saline instilled into the bladder.

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Acknowledgements

We thank Bendix Carstensen of the Clinical Epidemiology and Biostatistics Unit at the Royal Children’s Hospital for all his help and advice with the statistics related to this study. This study was presented at the 2003 Annual Meeting of the Paediatric Intensive Care Society [21]

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Correspondence to Peter J. Davis.

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Davis, P.J., Koottayi, S., Taylor, A. et al. Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Med 31, 471–475 (2005). https://doi.org/10.1007/s00134-004-2539-3

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Keywords

  • Intra-abdominal pressure
  • Intra-abdominal hypertension
  • Intra-vesical pressure
  • Children