Measurement of hydrostatic intraperitoneal pressure: a useful tool for the improvement of dialysis dose prescription

Abstract

The prescription of peritoneal dialysis should be individualized based on parameters of tolerance and adequacy. Determination of the intraperitoneal fill volume is essential for optimal patient care. Fill volume enhancement is a factor of exchange surface area recruitment: the wetted, contact peritoneal dialysis membrane. Nevertheless, fill volume enhancement can also lead to patient discomfort, with the potential risk of too high an intraperitoneal pressure (hernia, gastro-esophageal reflux). The perception of the individual patient is also a subjective parameter of fill volume tolerance assessment. In contrast, measurement of the hydrostatic intraperitoneal pressure (IPP, cmH(2)O) allows an objective approach to fill volume tolerance. From our clinical experience of more than 10 years of IPP measurements in child care, we can give a recommendation for normal values in children: less than 18 cm of water, usually between 5 and 15 cm, correlated to the intraperitoneal fill volume (naturally), but individually taking into account age, gender, "accustomization" and overall body mass index.

Diálisis peritoneal automática adaptada: un método de prescripción eficaz, eficiente y seguro

“…Estas herramientas son la prueba de equilibrio peritoneal (PEP), y la medición de la presión hidrostática intraperitoneal (PIP). Ambas han sido ampliamente descritas en la literatura (6)(7)(8)(9) . Siguiendo las modalidades antes descritas, DPA y DPCA, este objetivo no será fácil de alcanzar; ya que la eficacia de la DP dependerá de modificar los tiempos y los volú-menes de las permanencias.…”

A Reference Equation for Objectively Adjusting Dwell Volume to Obtain More Ultrafiltration in Daily Practice of Peritoneal Dialysis

“…[11] The intraperitoneal pressure was measured in the supine position as previously described, [5,12] just after instillation of a defined dialysate volume (P 0 ) and before the dialysate was drained four hours later (P 4 ). The difference between P 0 and P 4 was defined as ΔIPP.…”

The Neglected Role of Abdominal Compliance in Organ-Organ Interactions

“…During laparoscopy with limitation of insufflation pressures at 12 to 15 mmHg, the IAV did not reach a critical point at which an exponential increase in IAP occured [13]. As discussed above, the initial phase of the PV curve may indeed be linear (as observed during laparoscopy) but the remaining part is curvilinear or rather exponential [13][14][15]. Because of this exponential relationship, it is important to know both the shape and the position on the curve, as the actual position will determine the corresponding C ab .…”