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Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study
Intensive Care Medicine Experimental Pub Date : 2021-05-24 , DOI: 10.1186/s40635-021-00386-8
T. Kaussen , M. Gutting , F. Lasch , D. Boethig , A. von Gise , J. Dingemann , H. Koeditz , T. Jack , M. Sasse , P. Beerbaum , M. Boehne

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). 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). 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. 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

中文翻译:

危重病儿童连续胃内监测腹腔内压力:一项验证研究

在重症儿童中,腹腔内高压(IAH> 10 mmHg)和腹腔室综合征(ACS = IAH +器官功能障碍)的检测是最重要的,并且通常以目前的标准通过膀胱内压(IVP)进行监测。然而,IVP具有重要的缺点,即费时,不连续,通过依赖观察者的操作具有感染风险,并且对于导管的尺寸不确定。因此,我们试图验证基于空气囊的胃内压力测量(ACM-IGP)。根据腹部室社会验证标准,我们在体内和体外均对ACM-IGP和IVP进行了比较(水柱)。我们控制了患者的年龄,入院诊断,胃填充/推进药物,呼吸状况,镇静水平和经尿道导管,所有都会影响腹腔内压力(IAP)。最后,在重症监护病房(PICU)中招募了n = 97名儿童(中位年龄为1.3岁[范围0天至17岁],LOS-PICU 8.0 [1-332]天,PRISM-III-评分13 [0-35] ])。在n = 2.770个测量对中,IAP的中位数为6.7 [0.9–23.0] mmHg,n = 38(39%)儿童的IAH> 10 mmHg,n = 4。与IVP(r2 0.98)相比,在体外针对水柱的情况下,ACM-IGP具有完美的相关性(r2 0.99,平均偏差-0.1±0.5 mmHg,一致性极限(LOA)-1.1 / + 0.9,百分比误差[PE] 12%) ,偏压+ 0.7±0.6毫米汞柱,LOA-0.5 / + 1.9,PE 15%)。对于较大的IVP导管,在较高压力水平下,IVP会低估对水柱的压力。在体内,这两种技术之间的一致性很强(r2 0.95,偏差0.3±0.8 mmHg,LOA-1.3 / + 1.9 mmHg,PE 23%)。没有观察到预定义的控制变量对测量协议的影响。在IAH患病率较高的大量PICU人群中,ACM-IGP与IVP达成了一致。ACM-IGP的更广泛使用可以提高危重儿童中ACS的检出率。试用注册WHO-ICTRP-No。DRKS00006556(德国临床试验注册簿)。2014年9月12日注册,URL:https://www.drks.de/drks_web/navigate.do?navigationId = trial.HTML&TRIAL_ID = DRKS00006556
更新日期:2021-05-24
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