Department of Intensive Care, Ziekenhuis Netwerk Antwerpen (ZNA) Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium.
Ann Intensive Care. 2012 Jul 5;2 Suppl 1(Suppl 1):S10. doi: 10.1186/2110-5820-2-S1-S10.
The aim of this study was to determine whether intra-abdominal pressure (IAP) monitoring using the FoleyManometer (Holtech Medical, Charlottenlund, Denmark) increases the risk of urinary tract infection (UTI).
A retrospective database review was conducted.
The study was conducted in the 12-bed medical intensive care unit of ZNA Stuivenberg Hospital (Antwerp, Belgium), a tertiary hospital.
There were 5,890 patients admitted to the medical intensive care unit of which 1,097 patients underwent intrabladder pressure (IBP) monitoring as estimate for IAP.
Crude and adjusted UTI rates were compared among patients undergoing IAP measurements with three different intrabladder methods: a modified homemade technique, a FoleyManometer with 35 ml reservoir, and a FoleyManometer low volume (FoleyManometerLV) with less than 10 ml priming volume.
Four consecutive time periods of 24 months were defined and compared with regard to IAP measurement: period 1 (2000-2001), during which IAP monitoring was not used routinely (which serves as a control group), was compared with period 2 (2002-2003), using a modified homemade technique; period 3 (2004-2005), introducing the FoleyManometer; and finally period 4 (2006-2007), in which the FoleyManometerLV was introduced. The incidence of IBP measurements increased from 1.4% in period 1 to 45.4% in period 4 (p < 0.001). At the same time, the Simplified Acute Physiology Score (version 2) (SAPS-II) increased significantly from 24.4 ± 21.5 to 34.9 ± 18.7 (p < 0.001) together with the percentage of ventilated patients from 18.6% to 40.7% (p < 0.001). In total, 1,097 patients had IAP measurements via the bladder. The UTI rates were adjusted for disease severity by multiplying each crude rate with the ratio of control versus study patient SAPS-II probability of mortality. Crude and adjusted UTI rates per 1,000 catheter days (CD) were on average 16.1 and 12.8/1,000 CD, respectively, and were not significantly different between the four time periods.
Intrabladder pressure monitoring as estimate for IAP either via a closed transducer technique or the closed FoleyManometer technique seems safe and does not alter the risk of UTI in critically ill patients.
本研究旨在确定使用 FoleyManometer（Holtech Medical，Charlottenlund，丹麦）监测腹腔内压（IAP）是否会增加尿路感染（UTI）的风险。
回顾性数据库研究。
研究在比利时安特卫普 ZNA Stuivenberg 医院（三级医院）的 12 张病床的重症监护病房进行。
共有 5890 名患者入住重症监护病房，其中 1097 名患者接受了膀胱内压（IBP）监测，以估计 IAP。
比较采用三种不同膀胱内方法进行 IAP 测量的患者的尿路感染率：改良自制技术、带 35ml 储液罐的 FoleyManometer 和带少于 10ml 预充量的 FoleyManometerLV。
将四个连续的 24 个月时间段定义为 IAP 测量：第 1 期（2000-2001 年）期间，不常规使用 IAP 监测（作为对照组），与第 2 期（2002-2003 年）期间使用改良自制技术进行比较；第 3 期（2004-2005 年）引入 FoleyManometer；最后是第 4 期（2006-2007 年），引入了 FoleyManometerLV。膀胱内压测量的发生率从第 1 期的 1.4%增加到第 4 期的 45.4%（p < 0.001）。与此同时，简化急性生理学评分（第 2 版）（SAPS-II）从 24.4 ± 21.5 显著增加到 34.9 ± 18.7（p < 0.001），同时接受通气治疗的患者比例从 18.6%增加到 40.7%（p < 0.001）。共有 1097 名患者通过膀胱进行了 IAP 测量。尿路感染率通过将每个粗率乘以对照组与研究患者 SAPS-II 死亡率概率的比值进行疾病严重程度调整。每 1000 个导管日（CD）的尿路感染率（UTI）分别为 16.1 和 12.8/1000 CD，在四个时间段之间无显著差异。
通过封闭传感器技术或封闭 FoleyManometer 技术测量膀胱内压以估计 IAP 似乎是安全的，不会改变危重症患者尿路感染的风险。
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