Alberto Federico García1, Álvaro Ignacio Sánchez2, Álvaro José Gutiérrez3, Juan Gabriel Bayona4, María Paula Naranjo4, Sebastián Lago3, Juan Carlos Puyana5. 1. Department of Surgery, Fundación Valle del Lili, Cali, Colombia. 2. Department of Surgery, Fundación Valle del Lili, Cali, Colombia; Center for Clinical Research (CIC), Fundación Valle del Lili, Cali, Colombia. Electronic address: alvaroisanchezortiz@gmail.com. 3. School of Medicine, Universidad ICESI, Cali, Colombia. 4. Center for Clinical Research (CIC), Fundación Valle del Lili, Cali, Colombia. 5. Department of Surgery, University of Pittsburgh, UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: In critically ill surgical patients undergoing abdominal negative-pressure wound therapy (NPWT), it remains uncertain whether or not intra-abdominal pressure (IAP) measurements should be obtained when NPWT is activated. We aimed to determine agreement between IAP measured with and without NPWT. METHODS: In this analytic cross-sectional study, critically ill surgical adults (≥18 y) requiring abdominal NPWT for temporary abdominal closure after a damage control laparotomy were selected. Patients with urinary tract injuries or with pelvic packing were excluded. Paired IAP measures were performed in the same patient, with and without NPWT; two different operators performed the measures unaware of the other's result. Bland-Altman methods assessed the agreement between the two measures. Subgroup analyses (trauma and nontrauma) were performed. RESULTS: There were 198 IAP measures (99 pairs) in 38 patients. Mean IAP with and without NPWT were 8.33 (standard deviation 4.01) and 8.65 (standard deviation 4.04), respectively. Mean IAP difference was -0.323 (95% confidence interval -0.748 to 0.101), and reference range for difference was -4.579 to 3.932 (P = 0.864). From 112 IAP measures (56 pairs) in 21 trauma patients, mean IAP difference was -0.268 (95% confidence interval -0.867 to 0.331), and reference range for the difference was -4.740 to 4.204 (P = 0.427). CONCLUSIONS: There was no statistically significant disagreement in IAP measures. IAP could be measured with or without NPWT. In critically ill surgical patients with abdominal NPWT for temporary abdominal closure, monitoring and management of IAP either with or without NPWT is recommended.
BACKGROUND: In critically ill surgical patients undergoing abdominal negative-pressure wound therapy (NPWT), it remains uncertain whether or not intra-abdominal pressure (IAP) measurements should be obtained when NPWT is activated. We aimed to determine agreement between IAP measured with and without NPWT. METHODS: In this analytic cross-sectional study, critically ill surgical adults (≥18 y) requiring abdominal NPWT for temporary abdominal closure after a damage control laparotomy were selected. Patients with urinary tract injuries or with pelvic packing were excluded. Paired IAP measures were performed in the same patient, with and without NPWT; two different operators performed the measures unaware of the other's result. Bland-Altman methods assessed the agreement between the two measures. Subgroup analyses (trauma and nontrauma) were performed. RESULTS: There were 198 IAP measures (99 pairs) in 38 patients. Mean IAP with and without NPWT were 8.33 (standard deviation 4.01) and 8.65 (standard deviation 4.04), respectively. Mean IAP difference was -0.323 (95% confidence interval -0.748 to 0.101), and reference range for difference was -4.579 to 3.932 (P = 0.864). From 112 IAP measures (56 pairs) in 21 traumapatients, mean IAP difference was -0.268 (95% confidence interval -0.867 to 0.331), and reference range for the difference was -4.740 to 4.204 (P = 0.427). CONCLUSIONS: There was no statistically significant disagreement in IAP measures. IAP could be measured with or without NPWT. In critically ill surgical patients with abdominal NPWT for temporary abdominal closure, monitoring and management of IAP either with or without NPWT is recommended.
Authors: Alberto García; Mauricio Millán; Daniela Burbano; Carlos A Ordoñez; Michael W Parra; Adolfo González Hadad; Mario Alain Herrera; Luis Fernando Pino; Fernando Rodríguez-Holguín; Alexander Salcedo; María Josefa Franco; Ricardo Ferrada; Juan Carlos Puyana Journal: Colomb Med (Cali) Date: 2021-06-30