Comparison of indirect methods of measuring intra-abdominal pressure in children.
OBJECTIVE
To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children.


METHODS
Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia.


METHODS
20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery.


METHODS
IAP was measured directly via the peritoneal dialysis catheter and by intragastric manometry via an indwelling nasogastric tube, and by intravesical manometry via an indwelling transurethral urinary catheter, using volumes of 0, 1, 3 and 5 ml/kg body weight of sterile saline instilled into the bladder.


RESULTS
Across the range of IAPs of 1-8 mmHg the Bland-Altman method for assessing agreement between two methods of clinical measurement showed bladder pressure measured via the urinary catheter with 1 ml/kg body weight of saline instilled to be the most accurate indirect measurement technique, tending to give pressures between 0.07 and 1.23 mmHg higher than the direct measurement (95% CI for bias). Measuring bladder pressure with either no saline instilled or more saline per kilogram body weight instilled was less accurate over the same range of pressures, as was measuring the gastric pressure.


CONCLUSIONS
The most accurate indirect method of measuring IAP in children over the normal range of IAPs involves measuring bladder pressure via a transurethral urinary catheter with 1 ml/kg body weight of sterile saline instilled into the bladder.
Davis
Peter J
PJ
Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, UK. Peter.Davis@ubht.swest.nhs.uk
Koottayi
Satajyit
S
Taylor
Anna
A
Butt
Warwick W
WW
D000005:Abdomen / Q000503:physiopathology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D010372:Pediatrics / Q000295:instrumentation / Q000379:methods*; D010529:Peritoneal Cavity / Q000503:physiopathology; D010530:Peritoneal Dialysis / Q000295:instrumentation; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012965:Sodium Chloride; D013270:Stomach / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology
D012965:Sodium Chloride