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Am J Surg. 2007 May;193(5):644-7; discussion 647.

Effect of patient positioning on intra-abdominal pressure monitoring.

Author information

1
Faculty of Medicine, Foothills Medical Center, Foothills Hospital, University of Calgary, 1403-29th Street N.W., Calgary, Alberta, Canada, T2N 2T9.

Abstract

BACKGROUND:

Intra-abdominal hypertension affects multiple organ systems. Current measurement standard requires supine positioning, which jeopardizes patient safety by increasing the risk for ventilator-associated pneumonia. This study evaluated the relationship between intra-abdominal pressure (IAP) and head-of-bed (HOB) positioning in critically ill intubated patients.

METHODS:

IAP measurements were performed using intravesical catheters with manometry. IAP was measured in a range of patient HOB increases from 0 degrees to 45 degrees. Multivariable generalized estimating equation modeling was performed to describe the relationship between IAP and HOB positioning.

RESULTS:

Three hundred (300) observations were performed on 37 patients. In multivariable modeling, HOB increase was significantly associated with IAP. Body mass index, positive end-expiratory pressure, temperature, and diagnostic category were significant in this model, whereas age and Riker sedation score were not.

CONCLUSIONS:

There is a significant, positive association between IAP and HOB positioning in critically ill patients. Clinically relevant changes in IAP occur at HOB increases >20 degrees.

PMID:
17434374
DOI:
10.1016/j.amjsurg.2007.01.013
[Indexed for MEDLINE]

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