|Ahead of print publication
A study of intra-abdominal pressure measurement using a new innovative technique with Foley's catheter
Kedar Gorad, Vinod Prabhu
Department of Surgery, BVDUMCH, Sangli, Maharashtra, India
|Date of Submission||27-Sep-2020|
|Date of Decision||24-Nov-2020|
|Date of Acceptance||30-Nov-2020|
379/1, Flat No 1, Vardan Palace Apartment, Near Sphurti Chowk, Government Colony, Vishrambag, Sangli - 416 415, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: We aimed to study intra-abdominal pressure (IAP) measurement using a new innovative technique with Foley's catheter. Introduction: Intra-abdominal hypertension (IAH) is defined as an IAP equal to or above 12 mmHg (16.31 cm of water) (1 mmHg = 1.3 cm of water) and abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg along with organ malfunction. Effect of increased intra-abdominal tension is acute renal failure, pulmonary dysfunction, and decreased blood flow to the gastrointestinal organs. It may cause diaphragm elevation along with an increase in intrathoracic pressure causing pulmonary dysfunction and a decrease in the venous return to the brain leading to intracranial congestion and brain dysfunction. Increased IAP is commonly measured by recording intravesical pressure. In this study, we are using 50 ml of saline for urinary bladder pressure measurement through Foley's catheter. Methods: In this prospective study, we measured IAP by Foley's catheter in the urinary bladder in 250 patients which were admitted to our hospital. In this study, 196 patients were male and 54 patients were female. After establishing normal values in routine patients, the IAP was derived above which the values were considered as IAH. Results: Patients with laparoscopic abdominal surgeries, for example, laparoscopic appendectomy and/or laparoscopic cholecystectomy, obstructed hernia (enterocele) and intestinal obstruction, pancreatic ascites, pneumothorax, alcoholic liver disease with ascites, and chronic obstructive pulmonary disease, had raised IAP as compared to others. The average IAP of our patients who were routine patients was 7–9 cm of water. IAH was considered when values were above 9 cm of water. Conclusion: Our study showed that intravesical pressure measurement is a simple, minimally invasive method that may reliably estimate IAP in patients placed in supine position. When applied clinically, this should alert the clinician to take safety measures to avoid ACS.
Keywords: Abdominal compartment syndrome, intra-abdominal hypertension, intra-abdominal pressure, intravesical pressure
|How to cite this URL:|
Gorad K, Prabhu V. A study of intra-abdominal pressure measurement using a new innovative technique with Foley's catheter. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 13]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=316635
| Introduction|| |
Intra-abdominal hypertension (IAH) is defined as an intra-abdominal pressure (IAP) equal to or above 12 mmHg (16.31 cm of water) (1 mmHg = 1.3 cm of water) and abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg along with organ dysfunction. Effect of increased intra-abdominal tension is acute renal failure, pulmonary dysfunction, and decreased blood flow to the gastrointestinal organs. It may cause diaphragm elevation along with an increase in intrathoracic pressure causing pulmonary dysfunction and a decrease in the venous return to the brain leading to intracranial congestion and brain dysfunction., Clinically, significant IAH can be present in the absence of abdominal distension. Therefore, increased IAP is commonly measured by recording intravesical or urinary bladder pressure. Kron et al. were the first to describe this technique in 1984. Many techniques have been described for measuring IAP which may require complicated procedures and costly instruments, for example, placing pressure transducers directly into the abdominal cavity, the stomach, rectum, and inferior vena cava. We describe a simple and practical method of measuring the IAP which can be set up easily even in a peripheral hospital and has been validated in experimental and clinical studies. This technique uses the urinary bladder, an intra-abdominal and extraperitoneal organ, for indirect pressure measurement. The urinary bladder has a compliant wall which acts as a passive reservoir at volumes of <100 ml and is capable of transmitting abdominal pressure without imparting any additional pressure from its own musculature. Head high position in bed, adhesions, and loculations may give false measurements. Contraindication for the use of this technique is in patients with urinary bladder disease and those with traumatic bladder. In this study, we are using 50 ml of saline for urinary bladder pressure measurement through Foley's catheter. Our study aimed to determine the reliability of intravesical pressure measurement as an indirect measure of IAP.
| Methods|| |
Two hundred and and fifty patients were examined in our hospital by measuring intravesical pressure. In this study, 196 patients were male and 54 patients were female. After establishing normal values in routine patients, the IAP was derived above which the values were considered as IAH.
All patients with Foley's catheter were included in the study.
Patients with urinary symptoms, urinary bladder diseases, and bladder trauma and patients on ventilator were excluded.
The connector was connected to Foley's catheter. Three-way cannula with its attachment was used to connect the connector to pressure measurement device which is central venous pressure measurement cannula. 50cc simple disposable syringe attached to three-way cannula was used to inject saline into the bladder. Three-way cannula was useful to prevent air to come in and regurgitation of introduced saline. We measured the pressure in supine position and in centimeters of water [Figure 1].
The level of the symphysis pubis has been chosen for calibrating the pressure measurements. Once the connections are made, to avoid any artifacts, the pressure lumen catheters are flushed with a minimal amount of saline through the transducer channel to avoid any air bubble.
Name of IEC: Institutional Ethics Committee Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli.
Letter no: BV (DU) MC&H/Sangli/IEC/386/20.
| Results|| |
In our study, the age of patients was ranging from 16 to 85 years. Out of 250 patients, eight patients were postabdominal surgery patients, four patients were of obstructed hernia and intestinal obstruction, three patients were of pancreatic ascites, two patients are of pneumothorax, 16 patients were of alcoholic liver disease with ascites, two patients were of chronic obstructive pulmonary disease, and the remaining patients were of other medical conditions. The urinary bladder pressures reflected well the pressures in the abdominal cavity. Patients with laparoscopic abdominal surgeries, obstructed hernia (enterocele) and intestinal obstruction, pancreatic ascites, pneumothorax, alcoholic liver disease with ascites, and chronic obstructive pulmonary disease had raised IAP as compared to others, as shown in [Table 1]. In other patients, we got pressures within normal limits. By our method, the average IAP of our patients who were routine patients was 7–9 cm of water. IAH was considered when values were above 9 cm of water.
| Discussion|| |
The gold standard for IAP measurement is the intravesical technique., This method, originally developed by Kron, has subsequently been modified over the last 10 years by Iberti, Sugrue, Malbrain, and others.,,, The consequences of increased IAP and ACS are well known and are a source of significant morbidity and mortality in critically ill patients.,, Therefore, the ability to determine IAP by a simple, reliable, and noninvasive technique is of vital importance for the proper management of critically ill patients with IAH and taking the necessary measures to avoid the occurrence of ACS.,, There are many techniques of IAP measurements, namely gastric, rectal, vaginal, inferior vena cava, and direct peritoneal pressure. Transduction of intravesical pressure can be performed using a number of bladder techniques. These include the use of an interposition T-piece, direct cannulation of the urinary catheter using a transducer-based needle, or the insertion of a continuous transduction method using a three-way Foley's catheter. Bladder pressure measurements can also be performed continuously., However, recently bedside ICU monitors (Philips, Eindhoven, The Netherlands) provided a channel for labeled IAP recording. Some have expressed concerns regarding the possibility of inducing urinary tract infection due to the manipulation of the closed circuit of the urinary catheter and collection system. However, according to Cheatham et al. and Desie et al., this fear is unwarranted. In general, IAP measurements are simple to perform and re-producible and should be undertaken in high-risk patients in the ICU. Identification and management of IAH will improve outcomes and aid in decision-making in decompression and abdominal closure. In our study, intravesical pressure showed an indirect measurement of IAP with good results. Expected patients of raised IAP had higher values of intravesical pressure than normal patients, which proves the usefulness of urinary catheter method for IAP measurement.
| Conclusion|| |
Our study showed that intravesical pressure measurement is a simple, minimally invasive method that reliably estimates IAP in patients placed in supine position. Normal IAP in our study is 7–9 cm of water, and we consider 10 cm and above is increased IAP in our study. When applied clinically, this should alert the clinician to take safety measures to avoid ACS. Larger data and randomized control studies are required for further confirmation of effect of IAP on parameters such as duration of stay and outcome of patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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