Abstract
INTRODUCTION: Intraabdominal pressure (IAP) monitoring is recommended in all ventilated children according to the established guidelines. There is a knowledge gap about the relationship between IAP and lung mechanics among ventilated children. AIMS AND OBJECTIVES: This study aims to assess the correlation of IAP with lung mechanics among ventilated children. METHODS: This prospective observational study was conducted for 1-year at a 12-bed PICU of a tertiary care referral and teaching hospital in North India after obtaining IRB clearance. Children (1 month to 18 years) requiring ventilation in the PICU were eligible to participate after parental consent. Baseline demographic, blood gas, ventilatory, and lung mechanics parameters were recorded. The outcome measures such as IAP (by trans-bladder technique), peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean airway pressure (Pmean), dynamic lung compliance (Cdyn/kg) and static lung compliance (Cstat/Kg) were recorded every 6th hour till maximum 5 days of ventilation or until extubation or death, whichever was early. The primary outcome is to correlate between IAP and lung mechanics using Spearman's rank correlation coefficient (r) and the secondary outcome is to compare the correlations using the Fischer z-transformation method in injured vs. non-injured lung parenchyma, defined by oxygenation index (OI ≥vs< 4). RESULTS: The median(IQR) age among the 60 participants was 6 years (1.25-10) with male predilection (M: F 2:1). The median(IQR) of study parameters for IAP (mm Hg), Ppeak (cmH2O), Pplat (cmH2O), Pmean (cmH2O), Cdyn/kg (ml/kg/cmH2O) and Cstat/Kg (ml/kg/cmH2O) were 7(6,9), 18(16,22), 17(15,20), 10(9,12), 0.57(0.47,0.74) and 0.62(0.51,0.79) respectively. Intraabdominal hypertension(IAP>10 mm Hg) was present in 20 % of the patients. IAP had a positive correlation with Pmean (r = 0.41), Ppeak (r = 0.34), Pplat (r = 0.33) and a negative correlation with Cdyn/kg (r = -0.34), Cstat/kg (r=-0.35) in the study subjects (p<0.01). There was a higher correlation (r) observed among certain lung parameters with IAP in children with injured (Pmean = 0.4; Cdyn/kg = -0.35; Cstat/Kg= -0.4) versus non-injured (Pmean = 0.25; Cdyn/kg = -0.23; Cstat/Kg= -0.2) lung parenchyma (p <0.01). CONCLUSION: This study showed a significant correlation between IAP and lung mechanics. IAP was significantly associated with P mean, C dyn/Kg and C stat/Kg in children with injured lung parenchyma in comparison with non-injured lung parenchyma.