PURPOSE: To evaluate the accuracy of bladder pressures in the diagnosis and management of abdominal compartment syndrome (ACS).
METHODS: After Institutional Review Board(IRB) approval, nine operative abdominal trauma patients were prospectively studied over a 18-month period. Bladder pressures were compared to pressures obtained from intra-operatively placed electronic transducer located in the pelvis. Statistical analysis was performed using methods described by Bland and Altman.
RESULTS: A Bland-Altman plot of the differences of bladder and transducer pressures against the mean pressures is shown. There is little agreement between the two methods at low (10-15 mmHg) and high (30-70 mmHg) pressures. At higher pressures, there is a significant negative bias. No patients required a re-operation. There was no mortality.
CONCLUSION: Measurements obtained from the urinary bladder did not agree well with those obtained from within the peritoneal cavity. Furthermore, abdominal pressures greater than 20 mmHg did not show signs of ACS in this selected population raising doubts about the utility of using abdominal pressures alone to manage ACS.
CLINICAL IMPLICATIONS: Based on our experience and this study, urinary bladder pressures may be inaccurate in the diagnosis and/or management of ACS. The negative bias in the urinary bladder pressures may, in fact, underestimate the true abdominal pressures. We propose that the clinical triad of acute deterioration in organ dysfunction, abdominal distention, and adequate intravascular volume be the trigger to act on the diagnosis of ACS.
DISCLOSURE: Nina Bowman, None.