The Correlation between Head of Bed Angle and Intra-Abdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial The correlation between HOB and IAP
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
Introduction: The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit.
Methods: In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0 , 15 , and 30 ). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05.
Results: The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15 and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0°and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°.
Conclusion: Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.
- Intra-abdominal Hypertension
- Head of Bed
- Critical care
- Compartment syndrome
- Supine Position
How to Cite
McBeth PB, Zygun DA, Widder S, Cheatham M, Zengerink I, Glowa J, et al. Effect of patient positioning on intra-abdominal pressure monitoring. The American journal of surgery. 2007;193(5):644-7.
Cheatham ML, De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Critical care medicine. 2009;37(7):2187-90.
Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome. Current opinion in critical care. 2016;22(2):174-85.
Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive care medicine. 2013;39(7):1190-206.
Malbrain M, Chiumello D, Cesana B, Reintam Blaser A, Starkopf J, Sugrue M, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol. 2014;80(3):293-306.
Kim IB, Prowle J, Baldwin I, Bellomo R. Incidence, risk factors and outcome associations of intra-abdominal hypertension in critically ill patients. Anaesthesia and intensive care. 2012;40(1):79-89.
Malbrain ML, Cheatham ML. Definitions and pathophysiological implications of intra-abdominal hypertension and abdominal compartment syndrome. The American Surgeon. 2011;77(7):s6-s11.
Hecker A, Hecker B, Hecker M, Riedel J, Weigand M, Padberg W. Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbeck's archives of surgery. 2016;401(1):15-24.
Starkopf J, Tamme K, Blaser AR. Should we measure intra-abdominal pressures in every intensive care patient? Annals of intensive care. 2012;2(S1):S9.
Murcia-Sáez IM, Sobrino-Hernandez ML, García-Lopez F, Córcoles-González V, Cortés-Monedero JL, Tendero-Egea A, et al. Usefulness of intra-abdominal pressure in a predominantly medical intensive care unit. Journal of critical care. 2010;25(1):175. e1-. e6.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive care medicine. 2007;33(6):951-62.
Ejike JC, Kadry J, Bahjri K, Mathur M. Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children. Intensive care medicine. 2010;36(2):329-35.
Bodnar Z. Intra-Abdominal Pressure Monitoring2017. 11 p.
Rauen CA, Makic MBF, Bridges E. Evidence-based practice habits: transforming research into bedside practice. Critical Care Nurse. 2009;29(2):46-59.
Shuster MH, Haines T, Sekula LK, Kern J, Vazquez JA. Reliability of intrabladder pressure measurement in intensive care. American Journal of Critical Care. 2010;19(4):e29-e39.
Yi M, Leng Y, Bai Y, Yao G, Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. Journal of critical care. 2012;27(2):222. e1-. e6.
Morejón CDDS, Lombardo TA, Barbeito TOT, Sandra BG. Effects of zero reference position on bladder pressure measurements: an observational study. Annals of intensive care. 2012;2(S1):S13.
Vasquez DG, Berg-Copas GM, Wetta-Hall R. Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure. Journal of Surgical Research. 2007;139(2):280-5.
society Tac. Intra-abdominal Hypertension and the Abdominal Compartment Syndrome: Updated Consensus Definitions and Clinical Practice Guidelines from the World Society of the Abdominal Compartment Syndrome 2013 [Available from: https://www.wsacs.org/images/2013%20Guidelines%20slide%20set.pdf.
Mahran GSK, Abd-Elshafy SK, Abd El Neem MM, Sayed JA. The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients. Journal of Nursing Education and Practice. 2018;8(6).
Cresswell AB, Jassem W, Srinivasan P, Prachalias AA, Sizer E, Burnal W, et al. The effect of body position on compartmental intra-abdominal pressure following liver transplantation. Annals of intensive care. 2012;2(S1):S12.
Blaser AR, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, et al. Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients—A Prospective Multicenter Study (IROI Study). Critical care medicine. 2019;47(4):535-42.
De Keulenaer B, De Waele J, Powell B, Malbrain M. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive care medicine. 2009;35(6):969-76.
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive care medicine. 2006;32(11):1722-32.
Regli A, Pelosi P, Malbrain ML. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Annals of intensive care. 2019;9(1):52.
Krebs J, Pelosi P, Tsagogiorgas C, Alb M, Luecke T. Effects of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension: a pilot study. Critical Care. 2009;13(5):R160.
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