Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study

T Kaussen; M Gutting; F Lasch; D Boethig; A von Gise; J Dingemann; H Koeditz; T Jack; M Sasse; P Beerbaum; M Boehne

doi:10.1186/s40635-021-00386-8

Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study

Intensive Care Med Exp. 2021 May 24;9(1):24. doi: 10.1186/s40635-021-00386-8.

Authors

T Kaussen^#^{1

2}, M Gutting^#³, F Lasch⁴, D Boethig³, A von Gise³, J Dingemann⁵, H Koeditz³, T Jack³, M Sasse³, P Beerbaum³, M Boehne³

Affiliations

¹ Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany. Kaussen.torsten@mh-hannover.de.
² Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, University Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Kaussen.torsten@mh-hannover.de.
³ Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
⁴ Institute of Biometry, Hannover Medical School, Hannover, Germany.
⁵ Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany.

^# Contributed equally.

Abstract

Background: In critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP).

Methods: We prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP).

Results: In tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days-17 years], LOS-PICU 8.0 [1-332] days, PRISM-III-Score 13 [0-35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9-23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r² 0.99, mean bias - 0.1 ± 0.5 mmHg, limits of agreement (LOA) - 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r² 0.98, bias + 0.7 ± 0.6 mmHg, LOA - 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r² 0.95, bias 0.3 ± 0.8 mmHg, LOA - 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed.

Conclusions: In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556.

Keywords: Abdominal compartment syndrome; Air capsule nasogastric tube; Intra-abdominal hypertension; Intra-abdominal pressure measurement; Intra-gastric pressure measurement; Paediatric intensive care.

Associated data

DRKS/DRKS00006556