Valentin Becker Roland M. Schmid Andreas Umgelter Comparison of a new device for the continuous intra-gastric measurement of intra-abdominal pressure (CiMon) with direct intra-peritoneal measurements in cirrhotic patients during paracentesis Received: 26 September 2008 Accepted: 5 February 2009 Published online: 26 February 2009 Ó Springer-Verlag 2009 Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1451-2) contains supplementary material, which is available to authorized users. V. Becker Á R. M. Schmid Á A. Umgelter ( ) ) II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universita ¨t Mu ¨nchen, Ismaningerstr. 22, 81675 Munich, Germany e-mail: andreas.umgelter@lrz.tu- muenchen.de Tel.: ?49-89-41402265 Fax: ?49-89-41404808 Abstract Objective: To evaluate a new commercially available system for the intra-gastric measurement of intra-abdominal pressure (IAP). Design and setting: Prospective interventional trial in an intensive care unit of a university hospital. Patients: Ten patients with cirrhosis and tense ascites scheduled for para- centesis and instrumented with a ballon-tipped nasogastric tube. Inter- vention: Intermittent paracentesis with repeat paired measurements of IAP. Measurements and results: Intra-abdominal pressure was mea- sured directly through the paracentesis catheter using a scaled measurement gauge. Simultaneously, intra-gastric measurements were per- formed with the CiMon device (Pulsion Medical Systems, Munich, Germany), by means of a ballon-tip- ped nasogastric tube connected to a pressure transducer. The range of IAP was 6.5–28 mmHg for direct mea- surements and 3.7–16 mmHg for measurements obtained with the Ci- Mon device. The regression equation according to Passing and Bablok for the two methods had an intercept of 0.054 (95% CI–1.475–1.669) and a slope of 0.674 (95% CI 0.538–0.813). The cusum test showed a significant deviation from linearity (P \ 0.05). In the Bland–Altman test bias and limits of agreement were – 4.9 (±6.8) mmHg or, expressed as percentage of the average, -44% (±49%). Conclusion: Intra-gastric measur- ments of IAP using the CiMon device were not reliable enough to be clini- cally useful in these ascitic patients. Keywords Measurement Á Intra-abdominal pressure Á Intra-abdominal hypertension Á CiMon monitoring device Á Abdominal compartment syndrome Abbreviations ACS Abdominal compartment syndrome BMS Body mass index IAH Intra-abdominal hypertension IAP Intra-abdominal pressure MELD Model of end-stage liver disease Introduction Elevated intra-abdominal pressure (IAP) in critically ill patients is an increasingly recognized problem with an incidence ranging from 2 to 70% [1–3]. It may also be important for the development of renal failure in cirrhotic patients [4]. According to the Consensus Definition of the World Society of the Abdominal Compartment Syndrome (WSACS), IAP is the pressure concealed within the abdominal cavity. Intra-abdominal hypertension (IAH) is defined by the sustained or repe- ated elevation of IAP C 12 mmHg. In the abdominal Intensive Care Med (2009) 35:948–952 DOI 10.1007/s00134-009-1451-2 PHYSIOLOGICAL AND TECHNICAL NOTES