Validation of the urine column measurement as an estimation of the intra-abdominal pressure

The development, feasibility and credibility of intra-abdominal pressure measurement techniques: A scoping review

AIM

To provide a comprehensive overview on emerging direct and alternative methods for intra-abdominal pressure (IAP) measurement techniques.

METHODS

This was a scoping review study following Arksey and Malley's framework. The PubMed, EMBASE, Web of Science, EBSCO, Scopus and ProQuest databases were searched, and we only considered studies published from 2000 as we have extended the data from two previous reviews. Original studies that reported on the development, feasibility and credibility of IAP measurement techniques were included.

RESULTS

Forty-two of 9954 screened articles were included. IAP measurement techniques include three major categories: direct, indirect and less invasive measurement techniques. Agreement analyses were performed in most studies, and some explored the safety, time expenditure and reproducibility of IAP measurement techniques.

CONCLUSIONS

Clinical data assessing the validation of new IAP measurement techniques or the reliability of established measurement techniques remain lacking. Considering the cost and invasiveness, direct measurement is not recommended as a routine method for IAP measurement and should be preserved for critically ill patients where standard techniques are contraindicated or could be inaccurate. The measurement accuracy, reliability and sensitivity of the transrectal and transfemoral vein methods remain insufficient and cannot be recommended as surrogate IAP measures. Transvesical measurement is the most widely used method, which is the potentially most easy applicable technique and can be used as a reliable method for continuous and intermittent IAP measurement. Wireless transvaginal method facilitates the quantitative IAP measurement during exercise and activity, which laying the foundations for monitoring IAP outside of the clinic environment, but the accuracy of this technique in measuring absolute IAP cannot be determined at present. Less invasive technology will become a new trend to measure IAP and has substantial potential to replace traditional IAP measurement technologies, but further validation and standardization are still needed. Medical professionals should choose appropriate measurement tools based on the advantages and disadvantages of each IAP technique in combination with assessing specific clinical situations.

Assessment of Intra-Abdominal Pressure with a Novel Continuous Bladder Pressure Monitor-A Clinical Validation Study

INTRODUCTION

Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor.

METHODS

Adults having laparoscopic surgery and requiring urinary catheter intra-operatively were recruited to this single-arm validation study. IAP measurements using the novel monitor and a gold-standard foley manometer were compared. After anesthesia induction, a pneumoperitoneum was induced through a laparoscopic insufflator, and five randomly pre-defined pressures (between 5 and 25 mmHg) were achieved and simultaneously measured via both methods in each participant. Measurements were compared using Bland-Altman analysis.

RESULTS

In total, 29 participants completed the study and provided 144 distinct pairs of pressure measurements that were analyzed. A positive correlation between the two methods was found (R² = 0.93). There was good agreement between the methods, with a mean bias (95% CI) of -0.4 (-0.6, -0.1) mmHg and a standard deviation of 1.3 mmHg, which was statistically significant but of no clinical importance. The limits of agreement (where 95% of the differences are expected to fall) were -2.9 and 2.2 mmHg. The proportional error was statistically insignificant (p = 0.85), suggesting a constant agreement between the methods across the range of values tested. The percentage error was 10.7%.

CONCLUSIONS

Continuous IAP measurements using the novel monitor performed well in the clinical setup of controlled intra-abdominal hypertension across the evaluated range of pressures. Further studies should expand the range to more pathological values.

Measurement of intra-abdominal pressure in dogs and cats

OBJECTIVE

To review and summarize the human and veterinary literature on intra-abdominal pressure measurement techniques.

DATA SOURCES

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 DATA SYNTHESIS

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.

VETERINARY DATA SYNTHESIS

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.

CONCLUSIONS

Further studies investigating IAP in critically ill veterinary patients are required to establish the optimal technique for this measurement in veterinary medicine.