Impact of intra-abdominal pressure on early kidney transplant outcomes

Feasibility and accuracy of continuous intraabdominal pressure monitoring with a capsular device in human pilot trial

BACKGROUND

Intrabdominal pressure (IAP) is an important parameter. Elevated IAP can reduce visceral perfusion, lead to intraabdominal hypertension, and result in life-threatening abdominal compartment syndrome. While ingestible capsular devices have been used for various abdominal diagnoses, their application in continuous IAP monitoring remains unproven.

METHOD

We conducted a prospective clinical trial to evaluate the feasibility of IAP measurement using a digital capsule PressureDOT, an ingestible capsule equipped with wireless transmission capability and a pressure sensor, then compared its reliability with conventional intravesical method. Patients undergoing laparoscopic or robotic surgeries were recruited. During surgery, we created pneumoperitoneum by inflating CO2 into the peritoneal cavity and IAP was simultaneously monitored using both the ingestible capsules and intravesical measurements from Foley catheter. We assessed the feasibility of signal transmission and the accuracy of pressure measurements.

RESULTS

Six patients were enrolled in this pilot study. No adverse events were reported, and the average first-intake time was within 24 h. All capsules were successfully expelled, with an average excretion time of 81 h. In the summarized data, the mean IAPdot is 0.6 mmHg lower than the IAPivp, with a standard deviation of 1.68 mmHg. However, capsule measurements showed excellent correlation with intravesical IAP measurements, with an intraclass correlation coefficient of 0.916 (95% CI: 0.8821-0.9320).

CONCLUSION

Our study demonstrates the feasibility and safety of using digital capsules for continuous IAP monitoring, providing the agreement between IAP measurements from digital capsules and conventional intravesical measurement within a near-normal pressure.

Intra-abdominal hypertension and abdominal compartment syndrome

PURPOSE OF REVIEW

Intra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS.

RECENT FINDINGS

The impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes.

SUMMARY

In this manuscript, we provide an overview of recent insights and developments in the epidemiology, monitoring and treatment of patients with IAH and/or ACS.