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What is the normal intra-abdominal pressure in critically ill children and how should we measure it?

J Chiaka Ejike1, Khaled Bahjri, Mudit Mathur

  • 1Department of Pediatrics, Division of Pediatric Critical Care, Loma Linda University, School of Medicine, Loma Linda, California, USA. jejike@ahs.llumc.edu

Critical Care Medicine
|June 17, 2008
PubMed

Insights

The minimum optimal volume for accurate intra-abdominal pressure (IAP) measurement in children using the intravesical method is 3 mL. This study found the normal IAP in critically ill children to be 7 ± 3 mm Hg.

Area of Science:

  • Pediatric critical care medicine
  • Physiology
  • Medical instrumentation

Background:

  • The intravesical method is the gold standard for indirect intra-abdominal pressure (IAP) measurement.
  • Standard instillation volumes used in adults may not be accurate for pediatric patients.
  • Optimal instillation volumes for pediatric IAP measurement require further investigation.

Purpose of the Study:

  • Determine normal intra-abdominal pressure (IAP) in critically ill children.
  • Identify the optimal instillation volume for accurate IAP measurement using the intravesical method in children.

Main Methods:

  • Prospective observational study conducted in a tertiary pediatric intensive care unit.
  • Ninety-six mechanically ventilated children under 18 years old without intra-abdominal hypertension were enrolled.
  • Graduated instillation volumes (3-50 mL) of normal saline were used via urethral catheter to measure IAP with the AbViser device.

Main Results:

  • Normal intra-abdominal pressure (IAP) in critically ill children was 7 ± 3 mm Hg, consistent across weight groups.
  • The minimum optimal instillation volume for accurate IAP measurement was consistently 3 mL, regardless of patient weight.
  • Mean optimal volumes varied between weight strata, highlighting the importance of a standardized minimum volume.

Conclusions:

  • The mean intra-abdominal pressure (IAP) in critically ill children is 7 ± 3 mm Hg.
  • A minimum instillation volume of 3 mL is recommended for accurate pediatric IAP measurement via the intravesical method.
  • Intra-abdominal pressure (IAP) exceeding 10 mm Hg should be considered elevated in children.
Abstract

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