Critical Care

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Commentary

'Progression towards the minimum': the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures

Chad G Ball1 and Andrew W Kirkpatrick1,2*

Author Affiliations

1 Department of Surgery, Foothills Medical Center, University of Calgary, Alberta, Canada

2 Department of Critical Care Medicine, Foothills Medical Center, University of Calgary, Alberta, Canada

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Critical Care 2006, 10:153 doi:10.1186/cc4987

Published: 28 July 2006

Abstract

The abdominal compartment syndrome is a state of serious organ dysfunction. The syndrome results from sustained intra-abdominal hypertension, which is indirectly identified by measuring intra-bladder pressures (IBPs) using various priming volumes. This technique is poorly standardized across published data. Malbrain and Deeren have identified the risk of falsely elevated IBPs with instillation priming volumes greater than 50 ml. This overestimation appears to increase with larger priming aliquots. As a result, erroneous IBP measurements may incorrectly label a patient with the abdominal compartment syndrome, and therefore subject them to the potential complications of surgical and/or medical decompression techniques. The utility and benefit of using continuous IBP monitoring is discussed. These data require confirmation in other patient subgroups with younger ages, altered body mass indices and varied diagnoses.