Small Volume Instillation in Urinary Bladder Is as Accurate as the Standard Volume for Intra-Abdominal Pressure Measuring

Yanyong Thonhongsa, MD, Prompirun Wattanawiggid, MD, Panot Yimcharoen, MD, Apichart Ploysangwal, MD

Department of Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand

Background: Intra-abdominal pressure (IAP) is one of most important physiologic monitoring in the patient at risk of abdominal compartment syndrome. Transvesical measurement of the IAP is the gold standard for indirect IAP measurement. The recent study showed that instillation volumes have direct effect to intra-bladder pressure (IBP), especially in critical patient. The aim of this study was to evaluate the accuracy of small amount of volume instillation for IAP measurement compare with standard instillation volume 25 mL

Methods: In this experimental study, we have selected 13 patients who underwent laparoscopic cholecystectomy (LC), IBP was measured by using Foley catheter No.14 connected to port connector and nasogastric tube No.14 with the side holes cut off connected to pressure transducer to continuous monitor IBP. After IBP measuring tool was connected, urine in bladder was completely removed and set zero point at pubic symphysis level. During LC was performed IAP was set at 7 mmHg. Then sterile normal saline solution (NSS) 5 mL was infused into urinary bladder and wait for 30 seconds then mean IBP at 5 mL was recorded. The bladder was emptied, IBP were collected again as the previous procedure but with NSS 25 mL infusion. We then set IAP at 11 and 15 mmHg and record IBP of volume 5 and 25 mL again. The mean of each IBP was compared with IAP using Wilcoxon sign rank test.

Results: In total 13 patients, there were 5 male and 8 female patients. The age was range from 28 to 72 year old, median 57.5 year old. There was no difference between mean IBP at 5 mL compare with IAP at 7, 11 and 15 mmHg ( P value = 0.366, 0.470, and 0.169 respectively) and no difference between mean IBP at 25 mL compare with IAP at 7, 11 and 15 mmHg ( P value = 0.161, 0.271, and 0.218 respectively) as well.

Conclusion: Only 5 mL of NSS infuse into urinary bladder to obtain accurate IAP instead of 25 mL in normal patient, and may apply to critical patient as well. Limitation of this study is small sample size, the larger sample size should be conducted.

Session: Poster Presentation

Program Number: P384