American Journal of Clinical Medicine Research
ISSN (Print): 2328-4005 ISSN (Online): 2328-403X Website: Editor-in-chief: Dario Galante
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American Journal of Clinical Medicine Research. 2016, 4(1), 11-18
DOI: 10.12691/ajcmr-4-1-3
Open AccessArticle

Intra-abdominal Pressure is Influenced by Body Position?

António M. Lopes1, 2, , Andreia Nunes2, Maria M. R. E. Niza3 and António Dourado1

1University of Coimbra – Department of Informatics Engineering, Center for Informatics and Systems of the University of Coimbra (CISUC), Polo II University of Coimbra, 3030-290 Coimbra, Portugal

2University Lusofona – Faculty of Veterinary Medicine, Avenida do Campo Grande, 3761749-024 Lisboa, Portugal

3University of Lisbon - Faculty of Veterinary Medicine, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal

Pub. Date: March 25, 2016

Cite this paper:
António M. Lopes, Andreia Nunes, Maria M. R. E. Niza and António Dourado. Intra-abdominal Pressure is Influenced by Body Position?. American Journal of Clinical Medicine Research. 2016; 4(1):11-18. doi: 10.12691/ajcmr-4-1-3


Background: Increased intra-abdominal pressure (IAP) is a complication related to physio pathological changes with high rates of mortality and morbidity. Abdominal surgery is consider one of the risk factors that can increased IAP. Measurement can be done by direct or indirect methods, being the most used the transurethral (TM). However this method continues to generate some controversy. This study tries to clarify the doubts of the effect of body position when we use different methods to measure IAP. Methodology: Study realized an anatomical model in order to eliminate the described variables that influence IAP: abdominal and gastric contraction, micturition reflex and breathing. IAP was measured, directly, via microsensor and, indirectly, by TM and intragastric manometry, in five different body positions. The study population consists in a population of 29 anatomical model, 14 males and 15 females, with an average weight of 12.04 ± 5.67 kilograms (Kg). The inclusion criteria consisted in the absence of abdominal disease that would. Principal Findings: IAP determination by direct method showed no differences in the five body positions (P=0.765). The indirect method with better correlation with the direct was TM (cc0.87). Indirect methods revealed statistically significant differences with the direct, only in the Trendelenburg and reverse Trendelenburg. Conclusions: The clinical impact of this study is to decrease the doubts in the measurements of IAP. This study improves the knowledge of the application of the direct and indirect methods to accesses IAP. IAP is not affected by body position and the direct pressure value measured in all positions is constant. Only if the indirect methods are used, in Trendelenburg and reverse Trendelenburg positions, they may underestimate or overestimate IAP value. For the first time it was explained why this phenomenon occurs.

Abdominal surgery Intra-abdominal pressure transurethral method intragastric manometry body position

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[1]  Balogh Z, Moore F a., Moore EE, Biffl WL. Secondary abdominal compartment syndrome: A potential threat for all trauma clinicians. Injury. 2007;38(3):272-9.
[2]  Unit IC. Intraabdominal hypertension and abdominal compartment syndrome in the intensive care unit. 2006;1(1):13-5.
[3]  Aspesi M, Gamberoni C, Severgnini P, Colombo G, Chiumello D, Minoja G, et al. The abdominal compartment syndrome. Clinical relevance. Minerva Anestesiol [Internet]. 2002;68(4):138-46.
[4]  Joubert KE, Oglesby P a., Downie J, Serfontein T. Abdominal compartment syndrome in a dog with babesiosis. J Vet Emerg Crit Care. 2007;17(2):184-90.
[5]  Cheatham ML. Abdominal Compartment Syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med [Internet]. 2009;17(1):10. Available from:
[6]  Bosch L, Rivera del Alamo MM, Andaluz a., Monreal L, Torrente C, Garcia-Arnas F, et al. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats. Vet Rec [Internet]. 2012;171(24):622-622.
[7]  Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: Updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190-206.
[8]  Ameloot K, Gillebert C, Desie N, Malbrain MLNG. Hypoperfusion, Shock States, and Abdominal Compartment Syndrome (ACS). Surg Clin North Am. 2012;92(2):207-20.
[9]  Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand [Internet]. 2011;55(5):607-14. Available from:
[10]  Balogh ZJ, Martin A, van Wessem KP, King KL, Mackay P, Havill K. Mission to eliminate postinjury abdominal compartment syndrome. Arch Surg [Internet]. 2011;146(8):938-43.
[11]  Zhou T, Yang B, Zhang Y, Zhang L, Chen S. Study on intra-abdominal pressure in indirect inguinal hernia patients. Zhonghua Wai Ke Za Zhi. 2007;45:1455-7.
[12]  Peker K, Isik A, Inal A, Demiryilmaz I, Yilmaz I, Emiroglu M. How Lichtenstein hernia repair affects abdominal and anal resting pressures: a controlled clinical study. Int J Clin Exp Med [Internet]. 2014;7(2):363-9.
[13]  Lyons M, Mohan H, Winter DC, Simms CK. Biomechanical abdominal wall model applied to hernia repair. Br J Surg [Internet]. 2015;102(2):e133-9.
[14]  Suominen PK, Pakarinen MP, Rautiainen P, Mattila I, Sairanen H. Comparison of direct and intravesical measurement of intraabdominal pressure in children. J Pediatr Surg. 2006; 41(8): 1381-5.
[15]  Turnbull D, Webber S, Hamnegard CH, Mills GH. Intra-abdominal pressure measurement: validation of intragastric pressure as a measure of intra-abdominal pressure. Br J Anaesth [Internet]. 2007;98(5):628-34.
[16]  Pracca FF, Biestro AA, Moraes L, Puppo CB, Calvo SM, Gorrasi J, et al. Direct measurement of intra-abdominal pressure with a solid microtranducer. J Clin Monit Comput. 2007;21(3):167-70.
[17]  Malbrain MLNG. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30(3):357-71.
[18]  Lee SL, Anderson JT, Kraut EJ, Wisner DH, Wolfe BM. A simplified approach to the diagnosis of elevated intra-abdominal pressure. J Trauma [Internet]. 2002;52(6):1169-72.
[19]  Drellich, Sharon (University of California D. Intraabdominal Pressure and Abdominal Compartment Sydrome. Compend Contin Edu. 2000;22: N.o 8(Small Animal/Exotics):764-8.
[20]  Wauters J, Spincemaille L, Dieudonne AS, Van Zwam K, Wilmer A, Malbrain MLNG. A novel method (CiMON) for continuous intra-abdominal pressure monitoring: Pilot test in a pig model. Crit Care Res Pract. 2012;2012.
[21]  Ece I, Vatansev C, Kucukkartallar T, Tekin A, Kartal A, Okka M. The Increase of Intra-Abdominal Pressure Can Affect Intraocular Pressure. 2015;2015(08).
[22]  berti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology [Internet]. 1989;70(1):47-50.
[23]  Johna S, Taylor E, Brown C, Zimmerman G. Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients. Crit Care. 1999;3(6):135-8.
[24]  Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome. Anaesthesia. 2004;59(9):899-907.
[25]  Soler Morejón CDD, Lombardo TA, Tamargo Barbeito TO, Sandra BG. Effects of zero reference position on bladder pressure measurements: an observational study. Ann Intensive Care [Internet]. Springer Open Ltd; 2012;2 Suppl 1(Suppl 1):
[26]  Yi M, Leng Y, Bai Y, Yao G, Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. J Crit Care [Internet]. Elsevier Inc.; 2012;27(2):222.e1-222.e6.
[27]  Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma. 2001;50(2):297-302.
[28]  Smith SE, Sande AA. Measurement of intra-abdominal pressure in dogs and cats. J Vet Emerg Crit Care. 2012;22(5):530-44.
[29]  Collee GG, Lomax DM, Ferguson C, Hanson GC. Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intensive Care Med [Internet]. 1993;19(8):478-80.
[30]  Davis PJ, Koottayi S, Taylor A, Butt WW. Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Med. 2005;31(3):471-5.
[31]  Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W, Allen JE, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg. 1987;22(12):1207–11.
[32]  Engum S a., Kogon B, Jensen E, Isch J, Balanoff C, Grosfeld JL. Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome. J Pediatr Surg. 2002; 37(2): 214-8.
[33]  Metheny N a, Frantz R a. Head-of-bed elevation in critically ill patients: A review. Crit Care Nurse. 2013;33(3):53-67.
[34]  Pinsky MR (University of PMC, Laurent B (Hopital HM, Mancebo J (Hospital de SP, Antonelli M (Universita C des SC. Applied Physiology in Intensive Care Medicine 2. Third edit. Springer Heidelberg New York Dordrecht London; 2012. 220-224 p.
[35]  McBeth PB, Zygun DA, Widder S, Cheatham M, Zengerink I, Glowa J, et al. Effect of patient positioning on intra-abdominal pressure monitoring. Am J Surg. 2007;193(5 SPEC. ISS.):644-7.
[36]  De Keulenaer BL, De Waele JJ, Powell B, Malbrain MLNG. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Medicine. 2009. p. 969-76.
[37]  Rader RA, Johnson JA. Determination of normal intra-abdominal pressure using urinary bladder catheterization in clinically healthy cats. J Vet Emerg Crit Care. 2010;20(4):386-92.
[38]  Cresswell AG. Responses of intra-abdominal pressure and abdominal muscle activity during dynamic trunk loading in man. Eur J Appl Physiol Occup Physiol. 1993;66(4):315-20.
[39]  De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, Cresswell AB, et al. The effect of different reference transducer positions on intra-abdominal pressure measurement: A multicenter analysis. Intensive Care Med. 2008;34(7):1299-303.
[40]  Davis KG, Marras WS. The effects of motion on trunk biomechanics. Clin Biomech. 2000;15(10):703-17.
[41]  Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967-76.
[42]  Ahmadi-Noorbakhsh S, Malbrain ML. Integration of inspiratory and expiratory intra-abdominal pressure: a novel concept looking at mean intra-abdominal pressure. Ann Intensive Care [Internet]. Springer Open Ltd; 2012;2 Suppl 1(Suppl 1):S18. Available from:
[43]  Malbrain MLNG, Deeren DH. Effect of bladder volume on measured intravesical pressure: a prospective cohort study. Crit Care. 2006;10(4):R98.
[44]  Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg [Internet]. 1984;199(1):28-30. Available from:
[45]  Harman PK, Kron IL, McLachlan HD, Freedlender a E, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg [Internet]. 1982;196(5):594-7. Available from:
[46]  Cheatham M. Intraabdominal Pressure: A Revised Method for Measurement. J Am Coll Surg [Internet]. Elsevier; 1998 May 5 [cited 2015 Oct 9];186(5):594-5.
[47]  Conzemius MG, Sammarco JL, Holt DE, Smith GK. Clinical determination of preoperative and postoperative intra-abdominal pressures in dogs. Vet Surg VS Off J Am Coll Vet Surg. 1995;24(3):195-201.
[48]  Papavramidis TS, Marinis AD, Pliakos I, Kesisoglou I, Papavramidou N. Abdominal compartment syndrome - Intra-abdominal hypertension: Defining, diagnosing, and managing. J emergencies, trauma Shock. 2011;4(2):279-91.
[49]  Al-Dorzi HM, Tamim HM, Rishu AH, Aljumah A, Arabi YM. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care [Internet]. Springer Open Ltd; 2012;2(Suppl 1):S4. Available from:
[50]  Bosch L, del Alamo MMR, Andaluz A, Monreal L, Torrente C, Garcia-Arnas F, et al. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats. Veterinary Record. 2012.
[51]  Mahajna A, Mitkal S, Krausz MM. Postoperative gastric dilatation causing abdominal compartment syndrome. World J Emerg Surg. 2008;3:7.
[52]  Way LI, Monnet E. Determination and validation of volume to be instilled for standardized intra-abdominal pressure measurement in dogs. J Vet Emerg Crit Care. 2014;24(4):403-7.
[53]  Castellanos G, Piñero A, Fernández JÁ. La hipertensión intraabdominal y el síndrome compartimental abdominal: ¿qué debe saber y cómo debe tratarlos el cirujano? Cir Esp. 2007;81(1):4-11.
[54]  Van Wijk RM, Watts RW, Ledowski T, Trochsler M, Moran JL, Arenas GW. Deep neuromuscular block reduces intra-abdominal pressure requirements during laparoscopic cholecystectomy: a prospective observational study. Acta Anaesthesiol Scand. 2015;59(4):434-40.
[55]  Wilson WH. <Effect of Breathing on the Intra Abdominal Pressure.Pdf>. J Physiolo. 1933;Oct 25; 79:481-6.
[56]  Gudmundsson FF, Viste A, Gislason H, Svanes K. Comparison of different methods for measuring intra-abdominal pressure. Intensive Care Med. 2002;28(4):509-14.
[57]  Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma [Internet]. 2000;49(4):621-6; discussion 626-7. Available from: