Chart 3. Summary of articles discussing general aspects of intravesical intra-abdominal pressure (IAP) measurement.
| Objetives | Features | Results |
|---|---|---|
| To provide clinical update for accurate ACS diagnosis and for adequate management and intervention, with particular emphasis on intensive care(5) | Type: literature review | Simple, low cost; measurements in mmHg, at end-expiration, supine position, absence of abdominal contractions. Instillation of 25mL, transducer zeroed at mid-axillary line level and connected to 3-way stopcock inserted between vesical catheter and drainage bag. Measured in the presence of two or more risk factors every 4-6 hours; every hour in severe organ dysfunction. Discontinued in absence of acute organ dysfunction or if IAP <10mmHg for 24-48 hours |
| Place: Brazil | ||
| To provide updated information, discuss organ dysfunction mechanisms, technique, therapeutic recommendations and treatment(7) | Type: literature review | Reference standard for intermittent measurement. Volume: 20-25mL. Expressed in mmHg, measured at end-expiration, in complete supine position, in the absence of abdominal muscle contractions, with transducer zeroed at mid-axillary line level. Recent studies investigated effects of different zero-reference points and elevated head position |
| Place: Belgium | ||
| To give a broad overview of IAH/ACS, the role of nurses in assessment, monitoring and collaborative management(8) | Type: literature review. | Physical examination not sensitive for IAH detection. Intravesical method is the gold standard for indirect measurement, despite variations; technique adopted is: 20-25mL instillation volume, supine position, zero-reference point at pubic symphysis level, every 4-6 hours in patients at risk, until underlying cause resolution is obtained and IAP ≤12mmHg for 24-48 hours |
| Place: United States | ||
| To serve as reference for recommendations defined at the III World ACS Conference(9) | Type: experience report | Twelve consensus definitions. About the technique: reference standard for intermittent measurement; in mmHg, at end-expiration, in complete supine position, in the absence of abdominal muscle contractions, transducer zeroed on the mid-axillary line, at iliac crest level, 25mL maximum saline solution instillation volume |
| Place: Belgium | ||
| To describe diagnostic criteria, risk populations, monitoring techniques and IAH/ACS management(10) | Type: literature review | Gold standard due to reliability, simplicity and low invasiveness. Measured at end-expiration, zeroed at phlebostatic axis level, instillation of 25-50mL. Transient increase in sedation suggested to reduce interferences. Potential routine protocol: every 2 hours for the first 8 hours following ICU admission; every 4 hours over the next 8 hours; and every 8 hours over the following 24 hours |
| Place: United States | ||
| To review risk factors for IAH/ACS, related conditions, pathophysiology, diagnostic methods and therapeutic advancements(11) | Type: literature review | Physical examination and diagnosis have low sensitivity for IAH detection. Intravesical method simple, reliable, reproducible, minimally invasive, low cost, measured at end-expiration, in supine position, zero-reference point on the mid-axillary line at iliac crest level, in the absence of abdominal contractions, instillation of 25mL saline solution |
| Place: Spain | ||
| To provide a general overview and present historical aspects, definitions, pathophysiology and suggestions for IAH/ACS management(12) | Type: literature review | Physical examination and imaging modalities not sensitive for IAH detection. Safe, efficient monitoring: ≥2 risk factors, one baseline measurement; if IAH, serial measurements. Intravesical method is simple, low cost, thought to be the gold standard. Measurements taken with patient in supine position |
| Place: Greece | ||
| To present currently accepted consensus definitions regarding IAH and ACS diagnosis and treatment(13) | Type: literature review | Clinical assessment has low sensitivity in detection of increased IAP. Intravesical method more widely employed due to simplicity, low cost and minimal risk. Expressed in mmHg (=1.36cmH2O), at end-expiration, in complete supine position, in the absence of abdominal muscle contractions, zero-reference point at mid-axillary line level, instillation volume ≤25mL |
| Place: Belgium | ||
| To discuss etiology, epidemiological data, measurement techniques, diagnosis, complications, prevention | Type: literature review | Worldwide acceptance due to simplicity and minimal cost, but technique varies. Measured in mmHg, at end-expiration, in complete supine position, in the absence of abdominal contractions, with transducer zeroed at mid-axillary line level and maximal saline solution instillation volume of 25mL and treatment(14) |
| Place: Belgium | ||
| Not mentioned(17) | Type: literature review | Clinical assessment inaccurate for IAH detection. Measure: upon admission of critically-ill patient, in the presence of risk factors or clinical deterioration. Other hollow organs were described, but none as simple and user-friendly as the bladder. Patient in supine position, pressure module zeroed on the mid-axillary line at iliac crest level |
| Place: United States | ||
| To discuss etiology, epidemiological data, IAP measurement, diagnosis, complications, prevention and treatment options for ACS(18) | Type: literature review | Physical examination and imaging modalities inaccurate for diagnosis but indicate causes. IAP measured at one site is assumed to reflect IAP as a whole. Intravesical method is the gold standard due to simplicity and minimal cost. Several tools have been developed, such as Foley Manometer or AbViser stopcock. Continuous technique has been described, but is not widely used |
| Place: Belgium | ||
| Not mentioned(19) | Type: literature review | Patients must be in complete supine position and abdominal muscle contraction must be absent; transducer is zeroed at pubic symphysis or mid-axillary line level. Instillation of 25mL of sterile saline solution; values obtained must be expressed in mmHg |
| Place: Spain | ||
| Not mentioned(20) | Type: literature review | Clinical assessment has low sensitivity (40%) for IAH estimation. IAP increasingly employed due to relevance of early IAH detection and management; transducer zeroed at pubis level. Original technique employed 50-100mL but recent study reported better correlation with IAP when 50mL are used |
| Place: Chile | ||
| Not mentioned(28) | Type: specialist's opinion | Despite increased attention given to topic, general clinical application has not been established to date. Current consensus on ideal measurement method or time point is lacking. Future research efforts should aim to improve consensus definitions concerning IAH and ACS |
| Place: Belgium |
ACS: abdominal compartment syndrome; IAH: intra-abdominal hypertension; IAP: intra-abdominal pressure; ICU: intensive care unit.