The effect of different volumes and temperatures of saline on the bladder pressure measurement in critically ill patients

Davide Chiumello, Federica Tallarini, Monica Chierichetti, Federico Polli, Gianluigi Li Bassi, Giuliana Motta, Serena Azzari, Cristian Carsenzola, Luciano Gattinoni, Davide Chiumello, Federica Tallarini, Monica Chierichetti, Federico Polli, Gianluigi Li Bassi, Giuliana Motta, Serena Azzari, Cristian Carsenzola, Luciano Gattinoni

Abstract

Introduction: Intra-abdominal hypertension is common in critically ill patients and is associated with increased severity of organ failure and mortality. The techniques most commonly used to estimate intra-abdominal pressure are measurements of bladder and gastric pressures. The bladder technique requires that the bladder be infused with a certain amount of saline, to ensure that there is a conductive fluid column between the bladder and the transducer. The aim of this study was to evaluate the effect of different volumes and temperatures of infused saline on bladder pressure measurements in comparison with gastric pressure.

Methods: Thirteen mechanically ventilated critically ill patients (11 male; body mass index 25.5 +/- 4.6 kg/m2; arterial oxygen tension/fractional inspired oxygen ratio 225 +/- 48 mmHg) were enrolled. Bladder pressure was measured using volumes of saline from 50 to 200 ml at body temperature (35 to 37 degrees C) and room temperature (18 to 20 degrees C).

Results: Bladder pressure was no different between 50 ml and 100 ml saline (9.5 +/- 3.7 mmHg and 13.7 +/- 5.6 mmHg), but it significantly increased with 150 and 200 ml (21.1 +/- 10.4 mmHg and 27.1 +/- 15.5 mmHg). Infusion of saline at room temperature caused a significantly greater bladder pressure compared with saline at body temperature. The lowest difference between bladder and gastric pressure was obtained with a volume of 50 ml.

Conclusion: The bladder acts as a passive structure, transmitting intra-abdominal pressure only with saline volumes between 50 ml and 100 ml. Infusion of a saline at room temperature caused a higher bladder pressure, probably because of contraction of the detrusor bladder muscle.

Figures

Figure 1
Figure 1
IBPs measured at different volumes of saline and IGP: early versus late. Shown are the intra-bladder pressures (IBPs) measured at different volumes of saline (black circle indicates early recording, and white circle indicates late recording) and intra-gastric pressure (IGP; black square) at 10 cmH2O of positive end-expiratory pressure. ^P < 0.05 versus 50 and 100 ml saline; *P < 0.05 versus 50, 100, and 150 ml saline; °P < 0.05 versus late recording; †P < 0.05 versus intra-bladder pressure.
Figure 2
Figure 2
IBPs measures at different volumes of saline: saline at room temperature versus body temperature. The intra-bladder pressure (IBP) measured at the different volumes of saline (black circle indicates saline at room temperature, and white circle indicates saline at body temperature). ^P < 0.05 versus 50 and 100 ml saline; *P < 0.05 versus saline at room temperature.

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Source: PubMed

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