• Kay Choong See, Salar Tayebi, Chew Lai Sum, Jason Phua, Johan Stiens, Robert Wise, Amartya Mukhopadhyay, and MalbrainManu L N GMLNG0000-0002-1816-5255First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, Lublin, 20-954, Poland.Medical Data Management, Medaman, Geel, 2440, Belgium.International Fluid Acade.
• Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore. kaychoongsee@nus.edu.sg.
• J Clin Monit Comput. 2023 Oct 1; 37 (5): 135113591351-1359.

AbstractIncreased intra-abdominal pressure (IAP) is an important vital sign in critically ill patients and has a negative impact on morbidity and mortality. This study aimed to validate a novel non-invasive ultrasonographic approach to IAP measurement against the gold standard intra-bladder pressure (IBP) method. We conducted a prospective observational study in an adult medical ICU of a university hospital. IAP measurements using ultrasonography by two independent operators, with different experience levels (experienced, IAPUS1; inexperienced, IAPUS2), were compared with the gold standard IBP method performed by a third blinded operator. For the ultrasonographic method, decremental external pressure was applied on the anterior abdominal wall using a bottle filled with decreasing volumes of water. Ultrasonography looked at peritoneal rebound upon brisk withdrawal of the external pressure. The loss of peritoneal rebound was identified as the point where IAP was equal to or above the applied external pressure. Twenty-one patients underwent 74 IAP readings (range 2-15 mmHg). The number of readings per patient was 3.5 ± 2.5, and the abdominal wall thickness was 24.6 ± 13.1 mm. Bland and Altman's analysis showed a bias (0.39 and 0.61 mmHg) and precision (1.38 and 1.51 mmHg) for the comparison of IAPUS1 and IAPUS2 and vs. IBP, respectively with small limits of agreement that were in line with the research guidelines of the Abdominal Compartment Society (WSACS). Our novel ultrasound-based IAP method displayed good correlation and agreement between IAP and IBP at levels up to 15 mmHg and is an excellent solution for quick decision-making in critically ill patients.© 2023. The Author(s), under exclusive licence to Springer Nature B.V.

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