Thangarasa Tharshika, Foisy Dana, Leidecker Julie, Corsi Daniel J, Meggison Hilary, Blew Brian, Warren Jeffery, Zimmerman Deborah
Faculty of Psychiatry, University of Toronto, Toronto, ON, Canada.
Division of Nephrology, Department of Medicine, Ottawa Hospital, ON, Canada.
Can J Kidney Health Dis. 2019 Dec 6;6:2054358119892695. doi: 10.1177/2054358119892695. eCollection 2019.
Patients treated with peritoneal dialysis (PD) are at increased risk of developing mechanical complications such as dialysate leaks and hernias thought to be partially related to an increase in intra-abdominal pressure (IAP) secondary to dialysate in the abdomen. However, measurement of IAP requires specialized equipment that is not readily available in the home dialysis unit.
To develop a reliable method of measuring IAP in PD patients that could be easily used in the home dialysis unit. We hypothesized that the handheld Stryker pressure monitor would be suitable for this purpose via connection to the PD catheter.
Cross-sectional.
Tertiary Care Hospital, Ottawa, Ontario, Canada.
Patients who were having a PD catheter inserted via laparoscopic surgery at The Ottawa Hospital were recruited for the study.
With the patients at end-expiration, the IAP measured with the Stryker monitor connected to the PD catheter was compared with the insufflator pressures of 15, 10, and 5 mm Hg.
Bland-Altman plots were constructed and intraclass correlation coefficients were calculated for each pressure.
Twelve patients participated in the study: 9 men and 3 women. They were on average 53 ± 15 years old and 81 ± 13.4 kg. Two patients had to be excluded from the analysis due to difficulties zeroing the Stryker pressure monitor at the time of surgery. There were also rapid fluctuations in the insufflator pressure recording, creating additional challenges in comparing the 2 measurements at end-expiration. The 95% limits of agreement for the Bland-Altman plots ranged from 7.9 (@15 mm Hg) to 12.2 (@10 mm Hg). The intraclass correlation coefficients for reliability of the individual measurements ranged from 0.015 (10 mm Hg) to 0.634 (15 mm Hg).
Small sample size and lack of a gold standard comparator may have affected our results.
In our study, we used the operating room insufflator as the gold standard for measuring IAP. By Bland-Altman plots and intraclass correlation coefficients, the pressure values obtained with the Stryker pressure monitor were not a reliable estimate of insufflator IAP especially at lower pressures. Further studies are needed to identify an ideal tool for measurement of IAP to guide PD management.
接受腹膜透析（PD）治疗的患者发生机械性并发症（如透析液渗漏和疝气）的风险增加，这被认为部分与腹腔内透析液导致的腹腔内压力（IAP）升高有关。然而，IAP的测量需要专门设备，而家庭透析单元不易获得。
开发一种可在家庭透析单元轻松使用的测量PD患者IAP的可靠方法。我们假设手持式史赛克压力监测仪通过连接到PD导管适用于此目的。
横断面研究。
加拿大安大略省渥太华的三级护理医院。
招募了在渥太华医院通过腹腔镜手术插入PD导管的患者进行研究。
在患者呼气末，将连接到PD导管的史赛克监测仪测量的IAP与15、10和5 mmHg的气腹压力进行比较。
构建布兰德-奥特曼图并计算每个压力的组内相关系数。
12名患者参与了研究，9名男性和3名女性。他们的平均年龄为53±15岁，体重为81±13.4 kg。由于手术时史赛克压力监测仪调零困难，2名患者不得不被排除在分析之外。气腹压力记录也有快速波动，这给在呼气末比较这两种测量带来了额外挑战。布兰德-奥特曼图的95%一致性界限范围为7.9（@15 mmHg）至12.2（@10 mmHg）。个体测量可靠性的组内相关系数范围为0.015（10 mmHg）至0.634（15 mmHg）。
样本量小且缺乏金标准对照可能影响了我们的结果。
在我们的研究中，我们将手术室气腹机用作测量IAP的金标准。通过布兰德-奥特曼图和组内相关系数，史赛克压力监测仪获得的压力值不是气腹机IAP的可靠估计值，尤其是在较低压力时。需要进一步研究以确定用于测量IAP以指导PD管理的理想工具。
