Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients

In the present model, the bladder had higher baseline pressures than did the abdomen. Measurements across the bladder wall were not identical, but had high positive correlation coefficient when evaluated on an individual basis. Global analysis of the data for all patients showed a weak correlation coefficient.In the present study model, intra-cystic pressure did not reflect actual intra-abdominal pressure. In spite of some limitations in the study design, we feel that further research is warranted to identify other possible variables that may play a role in the relationship between the urinary bladder and the abdominal cavity pressures, providing better means for diagnosis of abdominal compartment syndrome.Abdominal compartment syndrome (ACS) is defined as the adverse physiologic consequence of acutely increased intra-abdominal pressure (IAP). Prolonged, unrelieved increased IAP at greater than 20mmHg can produce pulmonary compromise, renal impairment, cardiac failure, shock, and death [1,2,3,4,5,6].ACS is diagnosed by measuring intra-cystic pressure (ICP) as a reflection of IAP using a Foley catheter [4,7,8]. This technique was popularized by Kron et al [7] in 1984 after small animal studies. Human studies correlating ICP and IAP are lacking to date. To identify the relationship between the pressures across the urinary bladder wall, we simultaneously measured the pressures across the urinary bladder wall in 21 surgical patients in a prospective manner.After Institutional Review Board approval, and over the course of an 18-month period, we prospectively studied 21 patients who consented to participate the study as a part of their laparoscopic cholecystectomy. Pregnant women and children were excluded. No patient had a prior history of bladder dysfunction.After induction of anesthesia, and while the patient was still in a supine position, the bladder was evacuated by a standard Foley catheter. The Foley catheter was then primed with 50 cm3 of sterile saline. The ster