Bladder pressure measurement
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I haven't started a thread in a long time! Here goes!!!
Are any of you currently doing bladder pressure measurements to assess for abdominal compartment syndrome? Would you share your method and parameters with me?
The other night I was caring for a 15 kg child POD 2 liver retransplant who became anuric early in the shift. Girth was rising and the abdomen was quite tense. I had a continuous FFP infusion running in the CVP, but whenever I checked it the CVP was always normal. (Some question there since there was a series of t-pieces with soft tubing between the transducer tubing and the kid, and it was a tunnelled CVC.) Vent pressures hadn't really changed, gases were improving, LFTs improving, BUN and creatinine only slightly elevated, art pressures relatively stable on 5 of dop. Fluid balance hit +1.3 L by 0300, so the surgeon (an "adult" man) was called. He wanted us to do a bladder pressure, but we don't do those. So the resident got a procedure from the adult ICU across the hall that uses an angiocath and transducer set-up. He followed the instructions, did it twice and got two wildly different numbers, which really didn't mean much because we were using "adult" parameters. So we did an ultrasound, and the kiddie ended up going to the OR at change of shift for exploration.
If I'm ever in this spot again, I'd like some pediatric references to go with. Thanks.