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. 2019 Dec 6:6:2054358119892695.
doi: 10.1177/2054358119892695. eCollection 2019.

In Search of a Simple and Reliable Method of Measuring Intra-abdominal Pressure in Peritoneal Dialysis Patients

Tharshika Thangarasa  1 , Dana Foisy  2 , Julie Leidecker  3 , Daniel J Corsi  4 , Hilary Meggison  5 , Brian Blew  6 , Jeffery Warren  6 , Deborah Zimmerman  2   3
Affiliations

In Search of a Simple and Reliable Method of Measuring Intra-abdominal Pressure in Peritoneal Dialysis Patients

Tharshika Thangarasa et al. Can J Kidney Health Dis. .

Abstract
in English, French

Background: Patients treated with peritoneal dialysis (PD) are at increased risk of developing mechanical complications such as dialysate leaks and hernias thought to be partially related to an increase in intra-abdominal pressure (IAP) secondary to dialysate in the abdomen. However, measurement of IAP requires specialized equipment that is not readily available in the home dialysis unit.

Objectives: To develop a reliable method of measuring IAP in PD patients that could be easily used in the home dialysis unit. We hypothesized that the handheld Stryker pressure monitor would be suitable for this purpose via connection to the PD catheter.

Design: Cross-sectional.

Setting: Tertiary Care Hospital, Ottawa, Ontario, Canada.

Patients: Patients who were having a PD catheter inserted via laparoscopic surgery at The Ottawa Hospital were recruited for the study.

Measurements: With the patients at end-expiration, the IAP measured with the Stryker monitor connected to the PD catheter was compared with the insufflator pressures of 15, 10, and 5 mm Hg.

Methods: Bland-Altman plots were constructed and intraclass correlation coefficients were calculated for each pressure.

Results: Twelve patients participated in the study: 9 men and 3 women. They were on average 53 ± 15 years old and 81 ± 13.4 kg. Two patients had to be excluded from the analysis due to difficulties zeroing the Stryker pressure monitor at the time of surgery. There were also rapid fluctuations in the insufflator pressure recording, creating additional challenges in comparing the 2 measurements at end-expiration. The 95% limits of agreement for the Bland-Altman plots ranged from 7.9 (@15 mm Hg) to 12.2 (@10 mm Hg). The intraclass correlation coefficients for reliability of the individual measurements ranged from 0.015 (10 mm Hg) to 0.634 (15 mm Hg).

Limitations: Small sample size and lack of a gold standard comparator may have affected our results.

Conclusions: In our study, we used the operating room insufflator as the gold standard for measuring IAP. By Bland-Altman plots and intraclass correlation coefficients, the pressure values obtained with the Stryker pressure monitor were not a reliable estimate of insufflator IAP especially at lower pressures. Further studies are needed to identify an ideal tool for measurement of IAP to guide PD management.

Contexte: Les patients traités par dialyse péritonéale (DP) sont plus sujets aux complications mécaniques (hernies, fuites de dialysat) attribuées en partie à une augmentation de la pression intra-abdominale (PIA) due à l’accumulation de dialysat dans l’abdomen. La mesure de la PIA requiert toutefois de l’équipement spécialisé difficilement accessible en contexte de dialyse à domicile.

Objectif: Développer une méthode fiable, et facile à utiliser en contexte de dialyse à domicile, pour mesurer la PIA chez les patients traités par DP. Nous avons émis l’hypothèse qu’un tensiomètre portatif Stryker raccordé au cathéter de DP pourrait convenir à cet usage.

Type d’étude: Étude transversale.

Cadre: Un centre de soins tertiaires d’Ottawa (Ontario) au Canada.

Sujets: Des patients de l’hôpital d’Ottawa à qui on avait inséré un cathéter de DP par chirurgie laparoscopique.

Mesures: La pression intra-abdominale, mesurée en fin d’expiration à l’aide d’un tensiomètre Stryker raccordé au cathéter de DP, a été comparée aux pressions de 15, 10 et 5 mm Hg de l’insufflateur.

Méthodologie: Des courbes de Bland-Altman ont été établies et des coefficients de corrélation intraclasse ont été calculés pour chaque mesure de pression.

Résultats: Douze patients, soit neuf hommes et trois femmes, âgés de 53 ± 15 ans et pesant 81 ±13,4 kg en moyenne, ont participé à l’étude. Deux patients ont été exclus de l’analyse en raison de difficultés à remettre le tensiomètre Stryker à zéro au moment de l’intervention. On a observé de rapides fluctuations dans l’enregistrement de la pression avec l’insufflateur, ce qui a compliqué davantage la comparaison des deux mesures en fin d’expiration. Les limites de concordance à 95 % pour les courbes de Bland-Altman se situaient entre 7,9 (15 mm Hg) et 12,2 (10 mm Hg). Les coefficients de corrélation intraclasses pour la fiabilité des mesures individuelles s’échelonnaient entre 0,015 (10 mm Hg) et 0,634 (15 mm Hg).

Limites: Les résultats sont limités par la faible taille de l’échantillon et l’absence d’étalon-or pour la comparaison.

Conclusion: Pour cette étude, l’insufflateur de la salle d’opération a servi d’étalon-or pour la mesure de la PIA. Selon les courbes de Bland-Altman et les coefficients de corrélation intraclasses, les valeurs de pression obtenues avec le tensiomètre Stryker n’ont pas constitué une estimation fiable de la PIA de l’insufflateur, particulièrement pour les faibles valeurs de pression. Des études supplémentaires sont nécessaires pour proposer un outil de mesure fiable de la PIA afin de guider la gestion de la DP.

Keywords: intra-abdominal pressure; measurement; peritoneal dialysis (PD); pilot study.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study flow.
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