Reviewer's report
Title:Sensitivity of intra-abdominal, intra-organ and intravascular pressures in
detecting changes induced by external abdominal pressure with and without
PEEP: an experimental study
Version: 2Date:4 October 2009
Reviewer: marja boermeester
Reviewer's report:
The authors performed an interesting study in pigs to evaluate different methods
to measure intra-abdominal pressure, induced by a 7 kg weight, with or without
PEEP.
Major comments:
This study with all its efforts misses out on the essential question at hand. What
is the effect of level of PEEP on the level of elevated intra-abdominal pressure?
In other words: at the same 'real' intra-abdomminal pressure what level is
measured at high or low PEEP level. This question is not answered by present
study set-up. Only one PEEP level was used during artificial elevated
intra-abdominal pressure, so no comparison can be made. A far more interesting
set-up would have been to artifically elevate intra-abdominal pressure and
measure at different PEEP settings (0, 5, 10, 15 PEEP). Now we still don't know
whether the - too strict - Burch criteria and the clinically adhered cut-off level of
25 mmHg is influenced by the level of PEEP necessary in a particular patient.
The message that we can measure intra-abdominal pressure in many ways
reliably does not answer the only really important question: what level under what
circumstances requires an intervention?
Statistical analysis is adequate.
Minor comments:
Figures 1 and 2 are uninformative and hard to interpretate. Use medians and
range for the group and depict as such. If baseline measurements differ that
much among the twelve pigs it will be apparent in the ranges, or the experimental
setting is inadequate.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Sensitivity of intra-abdominal, intra-organ and intravascular pressures in
detecting changes induced by external abdominal pressure with and without
PEEP: an experimental study
Version: 2Date:4 October 2009
Reviewer: marja boermeester
Reviewer's report:
The authors performed an interesting study in pigs to evaluate different methods
to measure intra-abdominal pressure, induced by a 7 kg weight, with or without
PEEP.
Major comments:
This study with all its efforts misses out on the essential question at hand. What
is the effect of level of PEEP on the level of elevated intra-abdominal pressure?
In other words: at the same 'real' intra-abdomminal pressure what level is
measured at high or low PEEP level. This question is not answered by present
study set-up. Only one PEEP level was used during artificial elevated
intra-abdominal pressure, so no comparison can be made. A far more interesting
set-up would have been to artifically elevate intra-abdominal pressure and
measure at different PEEP settings (0, 5, 10, 15 PEEP). Now we still don't know
whether the - too strict - Burch criteria and the clinically adhered cut-off level of
25 mmHg is influenced by the level of PEEP necessary in a particular patient.
The message that we can measure intra-abdominal pressure in many ways
reliably does not answer the only really important question: what level under what
circumstances requires an intervention?
Statistical analysis is adequate.
Minor comments:
Figures 1 and 2 are uninformative and hard to interpretate. Use medians and
range for the group and depict as such. If baseline measurements differ that
much among the twelve pigs it will be apparent in the ranges, or the experimental
setting is inadequate.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Sensitivity of intra-abdominal, intra-organ and intravascular pressures in
detecting changes induced by external abdominal pressure with and without
PEEP: an experimental study
Version: 2Date:4 October 2009
Reviewer: marja boermeester
Reviewer's report:
The authors performed an interesting study in pigs to evaluate different methods
to measure intra-abdominal pressure, induced by a 7 kg weight, with or without
PEEP.
Major comments:
This study with all its efforts misses out on the essential question at hand. What
is the effect of level of PEEP on the level of elevated intra-abdominal pressure?
In other words: at the same 'real' intra-abdomminal pressure what level is
measured at high or low PEEP level. This question is not answered by present
study set-up. Only one PEEP level was used during artificial elevated
intra-abdominal pressure, so no comparison can be made. A far more interesting
set-up would have been to artifically elevate intra-abdominal pressure and
measure at different PEEP settings (0, 5, 10, 15 PEEP). Now we still don't know
whether the - too strict - Burch criteria and the clinically adhered cut-off level of
25 mmHg is influenced by the level of PEEP necessary in a particular patient.
The message that we can measure intra-abdominal pressure in many ways
reliably does not answer the only really important question: what level under what
circumstances requires an intervention?
Statistical analysis is adequate.
Minor comments:
Figures 1 and 2 are uninformative and hard to interpretate. Use medians and
range for the group and depict as such. If baseline measurements differ that
much among the twelve pigs it will be apparent in the ranges, or the experimental
setting is inadequate.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.
assistant