Defontaine Anne, Tirel Olivier, Costet Nathalie, Beuchée Alain, Ozanne Bruno, Gaillot Théophile, Arnaud Alexis Pierre, Wodey Eric
1Paediatric Intensive Care Unit, CHU Rennes, Rennes, France. 2INSERM, U1099, Rennes, France. 3Univ Rennes 1, Laboratoire de Traitement du Signal et de l'Image (LTSI), Rennes, France. 4Neonatal Intensive Care Unit, CHU Rennes, Rennes, France. 5Paediatric Surgery Department, CHU Rennes, Rennes, France. 6Univ Rennes 1, Faculty of Medicine, Rennes, France. 7CIC-P INSERM, U0203, Rennes, France. 8Anaesthesiology and Reanimation Department, CHU Rennes, Rennes, France.
Pediatr Crit Care Med. 2016 Feb;17(2):144-9. doi: 10.1097/PCC.0000000000000580.
To determine the optimal saline volume bladder instillation to measure intravesical pressure in critically ill newborns weighing less than 4.5 kg, and to establish a reference of intra-abdominal pressure value in this population.
Prospective monocentric study.
Neonatal ICU and PICU.
Newborns, premature or not, weighing less than 4.5 kg who required a urethral catheter.
Patients were classified into two groups according to whether they presented a risk factor for intra-abdominal hypertension. Nine intravesical pressure measures per patient were performed after different volume saline instillation. The first one was done without saline instillation and then by increments of 0.5 mL/kg to a maximum of 4 mL/kg. Linear models for repeated measurements of intravesical pressure with unstructured covariance were used to analyze the variation of intravesical pressure measures according to the conditions of measurement (volume instilled). Pairwise comparisons of intravesical pressure adjusted mean values between instillation volumes were done using Tukey tests, corrected for multiple testing to determine an optimal instillation volume. Forty-seven patients with completed measures (nine instillations volumes) were included in the analysis. Mean intravesical pressure values were not significantly different when measured after instillation of 0.5, 1, or 1.5 mL/kg, whereas measures after instillation of 2 mL/kg or more were significantly higher. The median intravesical pressure value in the group without intra-abdominal hypertension risk factor after instillation of 1 mL/kg was 5 mm Hg (2-6 mm Hg).
The optimal saline volume bladder instillation to measure intra-abdominal pressure in newborns weighing less than 4.5 kg was 1 mL/kg. Reference intra-abdominal pressure in this population was found to be 5 mm Hg (2-6 mm Hg).
确定体重小于4.5 kg的危重新生儿膀胱灌注生理盐水的最佳体积，以测量膀胱内压，并建立该人群腹内压值的参考标准。
前瞻性单中心研究。
新生儿重症监护病房和儿科重症监护病房。
体重小于4.5 kg、需要留置尿道导管的新生儿，无论是否早产。
根据是否存在腹内高压危险因素将患者分为两组。在不同体积生理盐水灌注后，对每位患者进行9次膀胱内压测量。第一次在不灌注生理盐水的情况下进行，然后以0.5 mL/kg的增量进行，最大至4 mL/kg。使用具有非结构化协方差的膀胱内压重复测量线性模型，分析膀胱内压测量值根据测量条件（灌注体积）的变化。使用Tukey检验对灌注体积之间的膀胱内压调整后平均值进行两两比较，并对多重检验进行校正，以确定最佳灌注体积。47例完成测量（9个灌注体积）的患者纳入分析。在灌注0.5、1或1.5 mL/kg后测量时，平均膀胱内压值无显著差异，而在灌注2 mL/kg或更多后测量值显著更高。在无腹内高压危险因素的组中，灌注1 mL/kg后膀胱内压的中位数为5 mmHg（2 - 6 mmHg）。
体重小于4.5 kg的新生儿测量腹内压的最佳膀胱灌注生理盐水体积为1 mL/kg。该人群的腹内压参考值为5 mmHg（2 - 6 mmHg）。
