Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study

Abstract

Background In critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP). Methods We prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP). Results In tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days–17 years], LOS-PICU 8.0 [1–332] days, PRISM-III-Score 13 [0–35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9–23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r2 0.99, mean bias − 0.1 ± 0.5 mmHg, limits of agreement (LOA) − 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r2 0.98, bias + 0.7 ± 0.6 mmHg, LOA − 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r2 0.95, bias 0.3 ± 0.8 mmHg, LOA − 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed. Conclusions In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

“…In the 2010 survey, we showed that most participants would measure IAP if measurement methods were easier to integrate into everyday clinical practice. The validation study of our research group could show that intragastric pressure measurement reflects IAP well and requires significantly less measurement effort [10].…”

Intra-abdominal hypertension and abdominal compartment syndrome

“…An air-capsule based measurement of gastric pressure has been developed and allows continuous pressure measurement. Kaussen et al [20] confirmed that also in paediatric patients, this compares favourably to intravesical pressure measurement.…”

Intra-Abdominal Hypertension and Compartment Syndrome after Pediatric Liver Transplantation: Incidence, Risk Factors and Outcome

“…We analyzed IAP by IVP as well as IGP measurements. Continuous IGP measurement is a less complex and less time-consuming method, which was recently validated by our group [ 23 ]. In contrast to IGP, IVP is known to underestimate IAP in patients who had liver transplant [ 31 ].…”

“…IGP was continuously measured using a commercially available system (Spiegelberg, Hamburg, Germany), whose methodology and reliability have already been described by us [ 23 ] and others [ 24 , 25 ]. IVP measurements were performed at least 12 times daily, and IGP values were documented hourly.…”