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Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 4/2022

Open Access 17-06-2021 | Obesity | Original Research

Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity

Authors: Shadi Hamoud, Siham Abdelgani, Michal Mekel, Safa Kinaneh, Ahmad Mahajna

Published in: Journal of Clinical Monitoring and Computing | Issue 4/2022

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Abstract

Intra-abdominal pressure (IAP) affects cardio-respiratory and hemodynamic parameters and can be measured directly or indirectly by measuring gastric or urinary bladder pressure. The aim of this study was to investigate the correlation between IAP, gastric pressure and urinary bladder pressure in patients with morbid obesity, at normal and elevated levels of IAP in two positions. As well, to examine the effects of increasing IAP and patient's position on hemodynamic and respiratory parameters. Twelve patients undergoing laparoscopic bariatric surgery were included. IAP, gastric pressure, and urinary bladder pressure were measured while patients were in the supine position and after 45° anti-Trendelenburg tilt. Mean inspiratory pressure, peak inspiratory pressure, and tidal volume were recorded and assessed. In supine position; directly measured IAP was 9.1 ± 1.8 mmHg, compared to 10 ± 3.6 and 8.9 ± 2.9 mmHg in the stomach and bladder, respectively. Increasing IAP to 15 mmHg resulted in an increased gastric pressure of 17 ± 3.8 mmHg, and urinary bladder pressure of 14.8 ± 3.9 mmHg. Gastric and urinary bladder pressures strongly correlated with IAP (R = 0.875 and 0.847, respectively). With 45° anti-Trendelenburg tilt; directly measured IAP was 9.4 ± 2.2 mmHg, and pressures of 10.8 ± 3.8 mmHg and 9.2 ± 3.8 mmHg were measured in the stomach and the bladder, respectively. Increasing IAP to 15 mmHg resulted in elevating gastric and bladder pressures to 16.6 ± 5.3 and 13.3 ± 4 mmHg, respectively. Gastric and urinary bladder pressures had good correlation with IAP (R = 0.843 and 0.819, respectively). Changing patient position from supine to 45° anti-Trendelenburg position resulted in decreased mean and peak inspiratory pressures, and increased tidal volume. Basal IAP is high in patients with morbid obesity. IAP shows positive correlation to gastric and urinary bladder pressures at both normal and elevated levels of IAP. Anti-Trendelenburg tilt of mechanically ventilated morbidly obese patients resulted in favorable effects on respiratory parameters.
Trial Registration: The study was retrospectively registered in the NIH registry. Registration number is pending.
Literature
1.
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I Definitions Intensive Care Med. 2006;32(11):1722–32.CrossRef
2.
Malbrain ML, Cheatham ML. Definitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome. Am Surg. 2011;77(Suppl 1):6–11.
3.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Wilmer A. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II Recommendations Intensive Care Med. 2007;33:951–62.CrossRef
4.
Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206. https://​doi.​org/​10.​1007/​s00134-013-2906-z.CrossRefPubMedPubMedCentral
5.
Wise R, Rodseth R, Blaser A, Roberts D, De Waele J, Kirkpatrick A, De Keulenaer B, Malbrain M. The Abdominal Compartment Society FTW Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of a repeat, international, cross-sectional survey. Anaesthesiol Intensive Ther. 2019;51(3):186–99. https://​doi.​org/​10.​5114/​ait.​2019.​87648.CrossRefPubMed
6.
De Waele JJ, Cheatham ML, Malbrain ML, Kirkpatrick AW, Sugrue M, Balogh Z, Ivatury R, De Keulenaer B, Kimball EJ. Recommendations for research from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. Acta Clin Belg. 2009;64:203–9.CrossRef
7.
Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma. 1998;45(3):597–609.CrossRef
8.
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28–30.CrossRef
9.
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996;76(4):833–42.CrossRef
10.
Fietsam R Jr, Villalba M, Glover JL, Clark K. Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg. 1989;55(6):396–402.PubMed
11.
Schein M, Wittmann DH, Aprahamian CC, Condon RE. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg. 1995;180(6):745–53.PubMed
12.
Rasmussen IB, Berggren U, Arvidsson D, Ljungdahl M, Haglund U. Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs. Eur J Surg. 1995;161(11):819–26.PubMed
13.
Simon RJ, Friedlander MH, Ivatury RR, DiRaimo R, Machiedo GW. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma. 1997;42(3):398–403.CrossRef
14.
Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg. 1999;134(10):1082–5.CrossRef
15.
Mlng M. Intra-abdominal pressure in the intensive care unit: clinical tool or toy? Yearbook of Intensive Care and Emergency Medicine. 2001;2001:2001.
16.
Mlng M. Abdominal perfusion pressure as a prognostic marker in intra-abdominal hypertension. Yearbook of Intensive Care and Emergency Medicine. 2002;2002(2002):792–814.
17.
Al-Abassi AA, Al Saadi AS, Ahmed F. Is intra-bladder pressure measurement a reliable indicator for raised intra-abdominal pressure? A prospective comparative study BMC Anesthesiol. 2018;18(1):69.CrossRef
18.
Obesity OWH. preventing and managing the global epidemic Report of a WHO Consultation. WHO Technical Report Series. 2000;894:252.
19.
Deitel M. The international obesity task force and “globesity.” Obes Surg. 2002;12(5):613–4.CrossRef
20.
Morris JA Jr, Eddy VA, Blinman TA, Rutherford EJ, Sharp KW. The staged celiotomy for trauma Issues in unpacking and reconstruction. Ann Surg. 1993;217(5):576–84.CrossRef
21.
Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001;182(6):542–6.CrossRef
22.
Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Brit J Surg. 2002;89(5):591–6.CrossRef
23.
Malbrain MLNG, De Iaet I, Van Regenmortel N, Schoonheydt K, Dits H, et al. Can the abdominal perimeter be used as an accurate estimation of intra-abdominal pressure? Crit Care Med. 2009;37(1):316–9.CrossRef
24.
Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg. 2002;26(12):1428–31.CrossRef
25.
Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30(3):357–71.CrossRef
26.
Wise RD, Rodseth RN, Correa-Martin L, Sanchez Margallo F, Becker P, Castellanos G, et al. Correlation between different methods of intraabdominal pressure monitoring in varying intraabdominal hypertension models. S Afr J Crit Care. 2017;33(1):15–8.
27.
Collee GG, Lomax DM, Ferguson C, Hanson GC. Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med. 1993;19(8):478–80.CrossRef
28.
Yol S, Kartal A, Tavli S, Tatkan Y. Is urinary bladder pressure a sensitive indicator of intra-abdominal pressure? Endoscopy. 1998;30(9):778–80.CrossRef
29.
Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma. 2001;50(2):297–302.CrossRef
30.
Sugerman H, Windsor A, Bessos M, Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med. 1997;241(1):71–9.CrossRef
31.
Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15(9):1225–32.CrossRef
32.
33.
Ho HS, Saunders CJ, Gunther RA, Wolfe BM. Effector of hemodynamics during laparoscopy: CO2 absorption or intra-abdominal pressure? J Surg Res. 1995;59(4):497–503.CrossRef
34.
Horvath KD, Whelan RL, Lier B, Viscomi S, Barry L, Buck K, et al. The effects of elevated intraabdominal pressure, hypercarbia, and positioning on the hemodynamic responses to laparoscopic colectomy in pigs. Surg Endosc. 1998;12(2):107–14.CrossRef
35.
Koivusalo AM, Lindgren L. Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2000;44(7):834–41.CrossRef
36.
Lindberg F, Bergqvist D, Björck M, Rasmussen I. Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs. Surg Endosc. 2003;17(3):480–4.CrossRef
Metadata
Title
Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity
Authors
Shadi Hamoud
Siham Abdelgani
Michal Mekel
Safa Kinaneh
Ahmad Mahajna
Publication date
17-06-2021
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 4/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-021-00728-7

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