Evaluation of a modified piezoresistive technique and a water-capsule technique for direct and continuous measurement of intra-abdominal pressure in a porcine model.

Abstract

Intravesical pressure measurement is considered to be the gold standard for the assessment of intra-abdominal pressure. However, this method is indirect and depends on a physiologic bladder function. We evaluated a modified piezoresistive technique and a water-capsule technique for direct and continuous intra-abdominal pressure measurement. Experimental study. Animal research laboratory. Eleven male domestic pigs. In anesthetized and mechanically ventilated animals, CO2 was insufflated to stepwise increase the intra-abdominal pressure to 30 mm Hg. Pressure was then held constant for 9 hrs followed by decompression. Piezoresistive measurement and water-capsule measurement probes were placed intra-abdominally. Readings of intravesical pressure measurement, piezoresistive measurement, and water-capsule measurement were taken hourly. Mean difference to insufflator readings, confidence intervals, and limits of agreement were calculated. Differences between applied pressure and intra-abdominal pressure readings were assessed using a two-factor analysis of variance. No significant differences between methods could be observed. During stepwise pressure increase, limits of agreements were -3.6 to 3.6 mm Hg. Confidence intervals were -3.4 to 3.5 (intravesical pressure measurement), -1.6 to 1.5 (piezoresistive measurement), and 0.5 to 2.9 mm Hg (water-capsule measurement). In the presence of constantly elevated intra-abdominal pressure, limits of agreement ranged from -8.2 to +8.2 mm Hg. Confidence intervals were -0.4 to 6.2 (intravesical pressure measurement), -0.2 to 2.7 (piezoresistive measurement), and 1.1 to 5.1 mm Hg (water-capsule measurement). Both piezoresistive measurement and water-capsule measurement had smaller confidence intervals than intravesical pressure measurement, indicating higher precision, whereas water-capsule measurement had a significant offset. Piezoresistive measurement could be the most suitable device for continuous direct intra-abdominal pressure monitoring in specific patients.