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Critical care medicine · Jul 2009
Multicenter Study Clinical TrialThe impact of body position on intra-abdominal pressure measurement: a multicenter analysis.
- Michael L Cheatham, Jan J De Waele, Inneke De Laet, Bart De Keulenaer, Sandy Widder, Andrew W Kirkpatrick, Adrian B Cresswell, Manu Malbrain, Zsolt Bodnar, Jorge H Mejia-Mantilla, Richard Reis, Michael Parr, Robert Schulze, Sonia Puig, and World Society of the Abdominal Compartment Syndrome (WSACS) Clinical Trials Working Group.
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA. michael.cheatham@orlandohealth.com
- Crit. Care Med. 2009 Jul 1;37(7):2187-90.
ObjectiveElevated 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.DesignProspective, cohort study.SettingTwelve international intensive care units.PatientsOne hundred thirty-two critically ill medical and surgical patients at risk for intra-abdominal hypertension and abdominal compartment syndrome.InterventionsTriplicate intravesicular pressure measurements were performed at least 4 hours apart with the patient in the supine, 15 degrees , and 30 degrees head of bed elevated positions. The zero reference point was the mid-axillary line at the iliac crest.Measurements And Main ResultsMean IAP values at each head of bed position were significantly different (p < 0.0001). The bias between IAPsupine and IAP15 degrees was 1.5 mm Hg (1.3-1.7). The bias between IAPsupine and IAP30 degrees was 3.7 mm Hg (3.4-4.0).ConclusionsHead 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.
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