TY - JOUR
T1 - The impact of body position on intra-abdominal pressure measurement
T2 - a multicenter analysis
AU - Cheatham, Michael L.
AU - De Waele, Jan J.
AU - De Laet, Inneke
AU - De Keulenaer, Bart
AU - Widder, Sandy
AU - Kirkpatrick, Andrew W.
AU - Cresswell, Adrian B.
AU - Malbrain, Manu
AU - Bodnar, Zsolt
AU - Mejia-Mantilla, Jorge H.
AU - Reis, Richard
AU - Parr, Michael
AU - Schulze, Robert
AU - Puig, Sonia
PY - 2009/1/1
Y1 - 2009/1/1
N2 - Objective: Elevated intra-abdominal pressure (IAP) is a frequent cause of morbidity and mortality among the critically ill. IAP is most commonly measured using the intravesicular or "bladder" technique. The impact of changes in body position on the accuracy of IAP measurements, such as head of bed elevation to reduce the risk of ventilator-associated pneumonia, remains unclear. Design: Prospective, cohort study. Setting: Twelve international intensive care units. Patients: One hundred thirty-two critically ill medical and surgical patients at risk for intra-abdominal hypertension and abdominal compartment syndrome. Interventions: Triplicate intravesicular pressure measurements were performed at least 4 hours apart with the patient in the supine, 15°, and 30° head of bed elevated positions. The zero reference point was the mid-axillary line at the iliac crest. Measurements and Main Results: Mean IAP values at each head of bed position were significantly different (p < 0.0001). The bias between IAPsupine and IAP 15° was 1.5 mm Hg (1.3-1.7). The bias between IAP supine and IAP30° was 3.7 mm Hg (3.4-4.0). Conclusions: Head of bed elevation results in clinically significant increases in measured IAP. Consistent body positioning from one IAP measurement to the next is necessary to allow consistent trending of IAP for accurate clinical decision making. Studies that involve IAP measurements should describe the patient's body position so that these values may be properly interpreted.
AB - Objective: Elevated intra-abdominal pressure (IAP) is a frequent cause of morbidity and mortality among the critically ill. IAP is most commonly measured using the intravesicular or "bladder" technique. The impact of changes in body position on the accuracy of IAP measurements, such as head of bed elevation to reduce the risk of ventilator-associated pneumonia, remains unclear. Design: Prospective, cohort study. Setting: Twelve international intensive care units. Patients: One hundred thirty-two critically ill medical and surgical patients at risk for intra-abdominal hypertension and abdominal compartment syndrome. Interventions: Triplicate intravesicular pressure measurements were performed at least 4 hours apart with the patient in the supine, 15°, and 30° head of bed elevated positions. The zero reference point was the mid-axillary line at the iliac crest. Measurements and Main Results: Mean IAP values at each head of bed position were significantly different (p < 0.0001). The bias between IAPsupine and IAP 15° was 1.5 mm Hg (1.3-1.7). The bias between IAP supine and IAP30° was 3.7 mm Hg (3.4-4.0). Conclusions: Head of bed elevation results in clinically significant increases in measured IAP. Consistent body positioning from one IAP measurement to the next is necessary to allow consistent trending of IAP for accurate clinical decision making. Studies that involve IAP measurements should describe the patient's body position so that these values may be properly interpreted.
KW - Abdominal compartment syndrome
KW - Intensive care
KW - Intra-abdominal hypertension
KW - Intra-abdominal pressure
KW - Intravesicular pressure
KW - Monitoring
UR - http://www.scopus.com/inward/record.url?scp=67649732911&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e3181a021fa
DO - 10.1097/CCM.0b013e3181a021fa
M3 - Article
C2 - 19487946
AN - SCOPUS:67649732911
SN - 0090-3493
VL - 37
SP - 2187
EP - 2190
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 7
ER -