Iacubovici Liat, Karol Dana, Baar Yuval, Beri Avi, Herzberg Haim, Zarour Shiri, Goren Or, Cohen Barak
Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel.
Urology Department, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel.
Life (Basel). 2023 Jan 30;13(2):384. doi: 10.3390/life13020384.
Intra-abdominal hypertension and the resulting abdominal compartment syndrome are serious complications of severely ill patients. Diagnosis requires an intra-abdominal pressure (IAP) measurement, which is currently cumbersome and underused. We aimed to test the accuracy of a novel continuous IAP monitor.
Adults having laparoscopic surgery and requiring urinary catheter intra-operatively were recruited to this single-arm validation study. IAP measurements using the novel monitor and a gold-standard foley manometer were compared. After anesthesia induction, a pneumoperitoneum was induced through a laparoscopic insufflator, and five randomly pre-defined pressures (between 5 and 25 mmHg) were achieved and simultaneously measured via both methods in each participant. Measurements were compared using Bland-Altman analysis.
In total, 29 participants completed the study and provided 144 distinct pairs of pressure measurements that were analyzed. A positive correlation between the two methods was found (R = 0.93). There was good agreement between the methods, with a mean bias (95% CI) of -0.4 (-0.6, -0.1) mmHg and a standard deviation of 1.3 mmHg, which was statistically significant but of no clinical importance. The limits of agreement (where 95% of the differences are expected to fall) were -2.9 and 2.2 mmHg. The proportional error was statistically insignificant ( = 0.85), suggesting a constant agreement between the methods across the range of values tested. The percentage error was 10.7%.
Continuous IAP measurements using the novel monitor performed well in the clinical setup of controlled intra-abdominal hypertension across the evaluated range of pressures. Further studies should expand the range to more pathological values.
腹内高压及由此导致的腹腔间隔室综合征是重症患者的严重并发症。诊断需要测量腹内压（IAP），目前该操作繁琐且未得到充分应用。我们旨在测试一种新型连续IAP监测仪的准确性。
招募接受腹腔镜手术且术中需要留置尿管的成年患者参与这项单臂验证研究。比较使用新型监测仪和金标准Foley测压计测量IAP的结果。麻醉诱导后，通过腹腔镜充气机建立气腹，在每个参与者中达到并同时通过两种方法测量五个随机预先定义的压力（5至25 mmHg之间）。使用Bland-Altman分析比较测量结果。
共有29名参与者完成了研究并提供了144对不同的压力测量值用于分析。发现两种方法之间存在正相关（R = 0.93）。两种方法之间具有良好的一致性，平均偏差（95% CI）为-0.4（-0.6，-0.1）mmHg，标准差为1.3 mmHg，具有统计学意义但无临床重要性。一致性界限（预计95%的差异会落在该范围内）为-2.9和2.2 mmHg。比例误差无统计学意义（= 0.85），表明在测试的整个值范围内两种方法之间具有恒定的一致性。百分比误差为10.7%。
在评估的压力范围内，使用新型监测仪进行连续IAP测量在控制性腹内高压的临床环境中表现良好。进一步的研究应将范围扩大到更多的病理值。
