• Jan J De Waele, Inneke De Laet, Bart De Keulenaer, Sandy Widder, Andrew W Kirkpatrick, Adrian B Cresswell, Manu Malbrain, Zsolt Bodnar, Jorge H Mejia-Mantilla, Richard Reis, Michael Parr, Robert Schulze, Sonia Compano, and Michael Cheatham.
• Surgical Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium. jan.dewaele@UGent.be
• Intensive Care Med. 2008 Jul 1; 34 (7): 1299-303.

ObjectiveTo investigate the effect of different reference transducer positions on intra-abdominal pressure (IAP) measurement. Three reference levels were studied: the symphysis pubis; the phlebostatic axis; and the midaxillary line at the level of the iliac crest.DesignProspective cohort study.SettingThe intensive care units of participating hospitalsPatients And ParticipantsOne hundred thirty-two critically ill patients at risk for intra-abdominal hypertension (IAH).InterventionsIn each patient, three sets of IAP measurements were obtained in the supine position, using the different reference levels. The IAP measurements obtained at the different reference levels were compared using a paired t-test and Bland-Altman statistics were calculated.Measurements And ResultsIAP(phlebostatic) (9.9 +/- 4.67 mmHg) and IAP(pubis) (8.4 +/- 4.60 mmHg) were significantly lower that IAP(midax) (12.2 +/- 4.66 mmHg; p < 0.0001 for both comparisons). The bias between the IAP(midax) and IAP(pubis) was 3.8 mmHg (95% CI 3.5-4.1) and 2.3 mmHg (95% CI 1.9-2.6) between the IAP(midax) and the IAP(phlebostatic). The precision was 3.03 and 3.40, respectively.ConclusionsIn the supine position, IAP(midax) is higher than both IAP(phlebostatic) and IAP(pubis), differences found to be clinically significant; therefore, the symphysis pubis or phlebostatic axis reference lines are not interchangeable with the midaxillary level.

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