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ORIGINAL ARTICLE
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A study of intra-abdominal pressure measurement using a new innovative technique with Foley's catheter


 Department of Surgery, BVDUMCH, Sangli, Maharashtra, India

Date of Submission27-Sep-2020
Date of Decision24-Nov-2020
Date of Acceptance30-Nov-2020

Correspondence Address:
Kedar Gorad,
379/1, Flat No 1, Vardan Palace Apartment, Near Sphurti Chowk, Government Colony, Vishrambag, Sangli - 416 415, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_544_20

  Abstract 


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 Top


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.[1] 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.[2],[3] Clinically, significant IAH can be present in the absence of abdominal distension.[4] 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.[5] 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.[6] 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.[7] 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 Top


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.

Inclusion criteria

All patients with Foley's catheter were included in the study.

Exclusion criteria

Patients with urinary symptoms, urinary bladder diseases, and bladder trauma and patients on ventilator were excluded.

Procedure

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].
Figure 1: Connections to Foley's catheter

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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 Top


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.
Table 1: Distribution of patients and their mean pressure

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  Discussion Top


The gold standard for IAP measurement is the intravesical technique.[8],[9] This method, originally developed by Kron, has subsequently been modified over the last 10 years by Iberti, Sugrue, Malbrain, and others.[4],[10],[11],[12] The consequences of increased IAP and ACS are well known and are a source of significant morbidity and mortality in critically ill patients.[1],[3],[6] 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.[1],[3],[13] There are many techniques of IAP measurements, namely gastric, rectal, vaginal, inferior vena cava, and direct peritoneal pressure.[14] 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.[15],[16] However, recently bedside ICU monitors (Philips, Eindhoven, The Netherlands) provided a channel for labeled IAP recording.[14] 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.[17] and Desie et al.,[12] 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.[18] 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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II recommendations. Intensive Care Med 2007;33:951-62.  Back to cited text no. 1
    
2.
Obeid F, Saba A, Fath J, Guslits B, Chung R, Sorensen V, et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg 1995;130:544-7.  Back to cited text no. 2
    
3.
Johna S, Taylor E, Brown C, Zimmerman G. Abdominal compartment syndrome: Does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients. Crit Care 1999;3:135-8.  Back to cited text no. 3
    
4.
Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): Time for a critical re-appraisal. Intensive Care Med 2004;30:357-71.  Back to cited text no. 4
    
5.
Gudmundsson FF, Viste A, Gislason H, Svanes K. Comparison of different methods for measuring intra-abdominal pressure. Intensive Care Med 2002;28:509-14.  Back to cited text no. 5
    
6.
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996;76:833-42.  Back to cited text no. 6
    
7.
Goel DS. Mjafi: Referencing patterns. Med J Armed Forces India 1997;53:70-1.  Back to cited text no. 7
    
8.
Kron IL. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1989;17:714-5.  Back to cited text no. 8
    
9.
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28-30.  Back to cited text no. 9
    
10.
Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1987;15:1140-2.  Back to cited text no. 10
    
11.
Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intra-abdominal pres-sure measurement using a modified nasogastric tube: Description and validation of a new technique. Intensive Care Med 1994;20:588-90.  Back to cited text no. 11
    
12.
Desie N, et al. Intra-abdominal pressure measurement using the Foley Manometer does not increase the risk for urinary tract infection in critically ill patients. Ann Intensive Care 2012;2 Suppl 1:S10.  Back to cited text no. 12
    
13.
Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: Validity and methodology. J Trauma 2001;50:297-302.  Back to cited text no. 13
    
14.
Sugrue M, Waele JJ, Keulenaer BL, Roberts DJ, Malbrain ML. A user's Guide to intra abdominal pressure 7 measurements. Anaesthesiol Intensive Ther 2015;47:241-51.  Back to cited text no. 14
    
15.
Balogh Z, De Waele JJ, Malbrain ML. Continuous Intra-abdominal pres-sure monitoring. Acta Clin Belg (Suppl) 2007;62:26-32.  Back to cited text no. 15
    
16.
Balogh Z, Jones F, D'Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure measurement technique. Am J Surg 2004;188:679-84.  Back to cited text no. 16
    
17.
Cheatham ML, Sagraves SG, Johnson JL, White MW. Intravesicular pressure monitoring does not cause urinary tract infection. Intensive Care Med 2006;32:1640-3.  Back to cited text no. 17
    
18.
Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W, Allen JE, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg 1987;22:1207-11.  Back to cited text no. 18
    


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    Tables

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