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Xu M, Zhang W, Sheng L, Hu M, Xu X. Biomimetic urine flow control can preserve bladder function in patients with indwelling catheterization. Medicine (Baltimore) 2023; 102:e36444. [PMID: 38050238 PMCID: PMC10695515 DOI: 10.1097/md.0000000000036444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
For patients with long-term indwelling catheterization, bladder function will be affected. It is necessary to explore whether biomimetic urine flow control (BUFC) can improve bladder function in patients undergoing indwelling catheterization. A retrospective, data-only, cohort study was carried out. The patients admitted to the intensive care unit, who had retained catheter and been continuously using a urodynamic monitoring system for over 30 days were selected. They were divided into 2 groups based on whether they were using BUFC function. The urodynamic monitoring data of the 2 groups were compared and analyzed. A total of 30 patients were included in the final analysis, including 15 in the BUFC group and 15 in the unobstructed group. The Urinary Volume and maximal urinary flow rate of the unobstructed group showed a continuous downward trend, while the BUFC group remained stable, and there was a statistical difference (P < .05) between the 2 groups since day 20. The bladder ultrasound imaging showed that the bladder volume of the BUFC group did not decrease significantly on the 30th day. BUFC technology, which provided by a urodynamic monitoring system, has potential protective effects of the bladder function after indwelling catheterization.
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Affiliation(s)
- Minrong Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lingxiang Sheng
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mahong Hu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiujuan Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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Li L, Zhang X, Cheng G, Wang D, Liu S, Li L, Shi N, Jin T, Lin Z, Deng L, Huang W, Windsor JA, Li G, Xia Q. Optimising the measurement of intra-bladder pressure in patients with predicted severe acute pancreatitis. Pancreatology 2023; 23:18-27. [PMID: 36503677 DOI: 10.1016/j.pan.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Measuring intra-abdominal pressure (IAP) is important for management of patients with severe acute pancreatitis (SAP). Intra-bladder pressure (IBP) is an indirect index that reflects IAP, but measuring techniques vary. We sought to optimise IBP measuring techniques in predicted SAP patients. METHODS Predicted SAP patients consecutively admitted between June 2018 and January 2020 were scrutinised. Eligible patients had their IBP monitored for the first 72 h at 6-h intervals, and were then sequentially allocated into three research scenarios: (1) in the supine position along with head of bed elevation(HoBE)of 0, 15 and 30° at various points including the iliac crest the midaxillary line, pubic symphysis, and right atrium level, instilled with 25 mL normal saline (NS) at room temperature (RT); (2) NS instillation volume from 0, 10, 25, 40-50 mL at the iliac crest with HoBE15 at RT; and (3) NS instillation (25 mL) at either RT or 37 °C with HoBE15. RESULTS The dynamic IBP values measured at the pubic symphysis and iliac crest were fairly similar between HoBE0 and HoBE15 (all P > 0.05), but greatly increased at HoBE30 (all P < 0.01). IBP was significantly increased with escalating instillation volumes of NS (all P < 0.01 versus 0 mL NS), while there was no significant difference between 25 mL and 10 mL (P = 0.055). IBP was similar between NS at RT and under 37 °C (P = 0.643). CONCLUSION In predicted SAP patients, measuring IBP at the iliac crest with HoBE15 after instilling 10 mL of NS seems to be appropriate for monitoring IAP.
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Affiliation(s)
- Linqian Li
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xiaoying Zhang
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guilan Cheng
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Dingxi Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Shiyu Liu
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lan Li
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Na Shi
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Jin
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ziqi Lin
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lihui Deng
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Huang
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - John A Windsor
- Centre for Surgical and Translational Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 92019, New Zealand
| | - Guixiang Li
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China.
| | - Qing Xia
- Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
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de Paula VB, Canola PA, Rivera GG, Z. Filho D, Amaral GPD, Ferraz GC, Ferraudo AS, Canola JC. Intrabladder pressure as predictor of intra-abdominal pressure in horses. PLoS One 2019; 14:e0223705. [PMID: 31600317 PMCID: PMC6786750 DOI: 10.1371/journal.pone.0223705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate effects of postural changes and bladder distention on intrabladder pressure whilst estimating intra-abdominal pressure in horses. DESIGN Two-year cohort study. Patients admitted for elective surgical procedures unrelated to gastrointestinal or genitourinary tract. SETTING School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil. ANIMALS 20 adult horses, 11 males (stallions and geldings) and 9 females; between 3.5 and 12 years, weighing 350 to 500 kg. INTERVENTIONS Intra-abdominal pressure was directly-recorded through abdominocentesis at the ventral midline with a fluid-filled system. Intrabladder pressure was obtained from a bladder catheter with the fluid-filled system zeroed at the level of the tuber ischia with patients in dorsal recumbency or pubic symphysis if in lateral recumbency. MEASUREMENTS AND MAIN RESULTS Body position directly influenced intra-abdominal pressure. In dorsal recumbency, intra-abdominal pressure differed (p < 0.05) from intrabladder pressure at end-inspiration and end-expiration regardless of whether the bladder was empty or distended. There was no correlation nor association between the two pressures in this body position. In lateral recumbency a difference (p <0.05) between intra-abdominal pressure and intrabladder pressure was recorded at end-inspiration with the bladder distended with 25 ml, and at end-expiration for distension volumes of 25 ml and 50 ml. There was a strong correlation between both pressures for left and right lateral recumbency, regardless of the distension volume. Ordinary least product (OLP) regression analysis showed no fixed or proportional bias between both pressures for distension volume of 50 ml, at both end-inspiration and end-expiration. CONCLUSIONS Indirect assessment of equine intra-abdominal pressure cannot be made in dorsal recumbency. For that purpose, patients should be in left lateral recumbency with the bladder distended with 50 ml. Values can be recorded at end-inspiration or end-expiration. RESTRICTION Occlusion of the catheter tip by the bladder wall when minimally distended.
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Affiliation(s)
- Vanessa B. de Paula
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Paulo A. Canola
- Department of Veterinary Medicine and Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
- * E-mail:
| | - Gabriela G. Rivera
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Dárcio Z. Filho
- Graduate Program in Veterinary Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Gabriel P. D. Amaral
- Residency Program in Large Animal Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Guilherme C. Ferraz
- Department of Animal Morphology and Physiology, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Antônio S. Ferraudo
- Department of Exact Sciences, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
| | - Júlio C. Canola
- Department of Veterinary Medicine and Surgery, São Paulo State University (Unesp), School of Agricultural and Veterinarian Sciences, Jaboticabal, SP, Brazil
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Hunt L, Frost SA, Alexandrou E, Hillman K, Newton PJ, Davidson PM. Reliability of intra-abdominal pressure measurements using the modified Kron technique. Acta Clin Belg 2015; 70:116-20. [PMID: 25287555 DOI: 10.1179/2295333714y.0000000083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Assessment of intra-abdominal pressure (IAP) and the likelihood of abdominal compartment syndrome using valid and reliable measures is an important tool in the assessment of critically ill patients. The current method of relying on a single IAP per measurement period to determine patient clinical status raises the question: is a single intermittent IAP measurement an accurate indicator of clinical status or should more than one measurement be taken per measurement period? METHODS This study sought to assess the reliability of IAP measurements. Measurements were taken using the modified Kron technique. A total of two transvesical intra-abdominal pressure measurements were undertaken per patient using a standardized protocol. Recordings were taken at intervals of 5 minutes. RESULTS The majority of participants (58%) were surgical patients. Thirty-two were males and the mean age was 58 years (SD: 16·7 years). The concordance correlation coefficient between the two measurements was 0·95. Both the scatter and Bland-Altman plots demonstrate that the comparisons of two measurements are highly reproducible. CONCLUSION The findings of this study suggest that conducting two IAP measurements on single patient produce comparable results; therefore, there appears to be no advantage in doing two IAP measurements on a single patient. The measurement of an IAP requires the implementation of a standardized protocol and competent and credentialed assessors trained in the procedure.
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A comparison of fluid instillation volumes to assess intra-abdominal pressure using Kron’s methods. J Trauma Acute Care Surg 2012; 73:152-5. [DOI: 10.1097/ta.0b013e31824e4f58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Canola PA, Perotta JH, Dias DPM, Canola JC, Johnson PJ, Valadão CAA. Alternative Intrabladder Manometry Technique for the Indirect Measurement of Intra-abdominal Pressure in Horses. J Equine Vet Sci 2012. [DOI: 10.1016/j.jevs.2011.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Duane TM, Brown H, Wolfe LG, Malhotra AK, Aboutanos MB, Ivatury RR. Bladder pressure measurements are an independent predictor of urinary tract infection in trauma patients. Surg Infect (Larchmt) 2010; 12:39-42. [PMID: 21171812 DOI: 10.1089/sur.2010.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine the risk factors for urinary tract infections (UTIs) specific to trauma patients in order to assist in the development of infection control protocols. METHODS Data were collected prospectively from January 2003 until December 2005 by an epidemiology nurse and combined with registry data from our Level 1 trauma center. The trauma patients admitted to the Surgery and Trauma Intensive Care Unit (STICU)(n = 938) who did and did not have UTIs were compared for demographics, Injury Severity Score (ISS), and epidemiologic data, including use of Foley catheters and bladder pressure measurements (BPMs). An open system was used for the measurements in which the catheter was disconnected from the bag to instill 50 mL of saline into the bladder, and an 18-gauge needle was inserted into the catheter to measure the pressure. RESULTS A total of 50 patients had no Foley catheter or UTIs. Among the 836 patients with catheters but no BPMs, there were 36 UTIs (4.31%), whereas the 52 patients with catheters and BPMs had 12 UTIs (23.08%)(p < 0.0001). Patients with UTIs were more severely injured older females (mean age 40.1 ± 18.6 years with no UTI vs. 48.5 ± 20.8 with UTIs; p = 0.0083; percent female 26.4 no UTI vs. 45.8 UTI; p = 0.007; ISS 19.3 ± 11.3 no UTI vs. 26.2 ± 11.6; p < 0.0001). Using logistic regression, BPM was an independent predictor of UTI, with infection being seven times more likely in the patients having the measurements (odds ratio [OR] 6.99; 95% confidence-interval [CI] 3.087-15.827). Along with age (OR 1.039; CI 1.024-1.054) and ISS (OR 1.081; CI 1.056-1.106), having BPMs was an independent predictor of death (OR 2.475; CI 1.191-6.328). CONCLUSION This is the first study that demonstrates a greater risk of UTI with BPM using the open technique independent of patient gender or degree of injury. Given these findings and a previous trial demonstrating no difference in UTI rates with a closed circuit for BPM, our institution has incorporated a closed circuit technique into its infection control protocol.
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Affiliation(s)
- Therèse M Duane
- Department of Surgery, Virginia Commonwealth University Medical Center, 1200 E. Broad Street, Richmond, VA 23298, USA.
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Intra-abdominal hypertension: detecting and managing a lethal complication of critical illness. AACN Adv Crit Care 2010; 21:205-19. [PMID: 20431449 DOI: 10.1097/nci.0b013e3181d94fd5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intra-abdominal hypertension occurs in 50% of all patients admitted to the intensive care unit and is associated with significant morbidity and mortality. Intra-abdominal hypertension is defined as a sustained, pathologic rise in intra-abdominal pressure to 12 mm Hg or more. Patients with intra-abdominal hypertension may progress to abdominal compartment syndrome. Early identification and treatment of this condition will improve patient outcome. Patients at risk for intra-abdominal hypertension include those with major traumatic injury, major surgery, sepsis, burns, pancreatitis, ileus, and massive fluid resuscitation. Predisposing factors include decreased abdominal wall compliance, increased intraluminal contents, increased peritoneal cavity contents, and capillary leak/fluid resuscitation.
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Lobo C, Twigg S. Ovarian Hyperstimulation Syndrome — The Role of Intra-Abdominal Pressure Monitoring. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ovarian hyperstimulation syndrome is a condition which includes symptoms of nausea, vomiting and abdominal pain. The accumulation of ascites can lead to respiratory compromise. We present a case where intra-vesical abdominal pressure monitoring was used to guide the timing of paracentesis.
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Affiliation(s)
- Clinton Lobo
- Clinton Lobo ST2 Anaesthetics and Intensive Care Medicine, Severn Deanery
| | - Steven Twigg
- Steven Twigg Consultant Anaesthetics and Intensive Care Medicine, Gloucestershire Royal Hospital
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Pearson EG, Rollins MD, Vogler SA, Mills MK, Lehman EL, Jacques E, Barnhart DC, Scaife ER, Meyers RL. Decompressive laparotomy for abdominal compartment syndrome in children: before it is too late. J Pediatr Surg 2010; 45:1324-9. [PMID: 20620339 DOI: 10.1016/j.jpedsurg.2010.02.107] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 02/23/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE Abdominal compartment syndrome (ACS) in children is an infrequently reported, rapidly progressive, and often lethal condition underappreciated in the pediatric population. This underrecognition can result in a critical delay in diagnosis causing increased morbidity and mortality. This study examines the clinical course of patients treated for ACS at our institution. METHODS A review of children requiring an emergency laparotomy (n = 264) identified 26 patients with a diagnosis of ACS. ACS was defined as sustained intraabdominal hypertension (bladder pressure >12 mm Hg) that was associated with new onset organ dysfunction or failure. RESULTS Patients ranged in age from 3 months to 17 years old and were cared for in the pediatric intensive care unit (PICU). Twenty-seven percent (n = 7) were transferred from referring hospitals, 50% (n = 13) were admitted directly from the emergency department, and 23% (n = 6) were inpatients before being transferred to PICU. Admission diagnoses included infectious enterocolitis (n = 12), postsurgical procedure (n = 10), and others (n = 4). Patients progressed to ACS rapidly, with most requiring decompressive laparotomy within 8 hours of PICU admission (range, <1-96 hours). Preoperatively, all patients had maximum ventilatory support and oliguria, 85% (n = 22) required vasopressors/inotropes, and 31% (n = 8) required hemodialysis. Mean bladder pressure was 25 mm Hg (range, 12-44 mm Hg). In 42% (n = 11), cardiac arrest preceeded decompressive laparotomy. All patients showed evidence of tissue ischemia before decompressive laparotomy with an average preoperative lactate of 8 (range, 1.2-20). Decompressive laparotomy was done at the bedside in the PICU in 13 patients and in the operating room in 14 patients. Abdominal wounds were managed with open vacuum pack or silastic silo dressings. Physiologic data including fluid resuscitation, oxygen index, mean airway pressure, vasopressor score, and urine output were recorded at 6-hour intervals beginning 12 hours before decompressive laparotomy and extending 12 hours after operation. The data demonstrate improvement of all physiologic parameters after decompressive laparotomy except for urine output, which continued to be minimal 12 hours post intervention. Mortality was 58% (n = 15) overall. The only significant factor related to increased mortality was bladder pressure (P = .046; odds ratio, 1.258). Cardiac arrest before decompressive laparotomy, need for hemodialysis, and transfer from referring hospital also trended toward increased mortality but did not reach significance. CONCLUSION Abdominal compartment syndrome in children carries a high mortality and may be a consequence of common childhood diseases such as enterocolitis. The diagnosis of ACS and the potential need for emergent decompressive laparotomy may be infrequently discussed in the pediatric literature. Increased awareness of ACS may promote earlier diagnosis, treatment, and possibly improve outcomes.
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Affiliation(s)
- Erik G Pearson
- Department of Surgery, University of Utah, Salt Lake City, UT 84113, USA
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