Original article
Comparison of direct and intravesical measurement of intraabdominal pressure in children

https://doi.org/10.1016/j.jpedsurg.2006.04.030Get rights and content

Abstract

Purpose

The aim of this study was to compare directly measured intraabdominal pressure with the pressure measured indirectly via urinary catheter using different bladder-filling volumes in children.

Methods

Prospective observational study in pediatric intensive care unit at a university children's hospital. Three simultaneous measurements of intraabdominal pressure were performed in 14 children, mean age 1.6 months (range, 0.2-56), after cardiac surgery requiring cardiopulmonary bypass directly via an intraperitoneal dialysis catheter and indirectly via indwelling urinary catheter with bladder volumes of 1, 1.5, 2, 2.5, and 3 mL/kg of physiological saline. Of the 14 patients, 9 were mechanically ventilated at the time of the intraabdominal pressure measurements.

Results

Directly measured intraabdominal pressure ranged between 0 and 10 mm Hg and showed the highest correlation (r = 0.971, P < .0001) with the pressure measured via urinary catheter using bladder-filling volume of 1 mL/kg. The higher the bladder-filling volume, the higher was the overestimation of the intraabdominal pressure and the weaker was the correlation with the direct measurement. Overestimation of intraabdominal pressure was 1.3, 2.0, and 2.9 mm Hg, with bladder volume of 1, 2, and 3 mL/kg, respectively.

Conclusion

These data suggest that intravesical pressure closely correlates with intraabdominal pressure in children. A bladder-filling volume of 1 mL/kg is recommended for the measurement of intraabdominal pressure in children with a risk of abdominal compartment syndrome.

Section snippets

Patients and methods

The Ethics Committee of the Children's Hospital, University of Helsinki, approved the study protocol. Parents of the children enrolled gave written informed consent. Fourteen pediatric cardiac surgery patients with an indwelling intraperitoneal catheter (Cook C-PDS-851U-PT, Bjaeverskov) installed in the operating room for ascites drainage and possible peritoneal dialysis were enrolled. All the included patients had a Foley urinary catheter (6-12 Ch).

All the patients underwent 3 separate

Results

The patient characteristics are shown in Table 1. The type of cardiac surgery performed was TCPC in 5 patients, arterial switch in 3, and repair of truncus arteriosus in 2. The remaining 4 patients underwent Norwood 1 operation and repair of aortic arch, tetralogy of Fallot, and atrioventricular septal defect, respectively. Operation required cardiopulmonary bypass (CPB) in all patients and aortic cross-clamp (ACC) in 10 patients (Table 1). Two patients had previously placed tube gastrostomy.

Discussion

This study shows that intraperitoneal pressure closely correlates with intravesical pressure in children. However, the use of intravesical volume of 1 mL/kg or higher for measurement of IAP via urinary catheter causes an overestimation of actual IAP that increases linearly with increasing bladder-filling volume. Generally, these findings are in line with previous studies in adult patients [13], [14]. Despite increasing use of bladder pressure as an estimation of actual IAP and importance of

References (17)

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