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This research aims to correlate airway pressure with intra-abdominal pressure during laparoscopic cholecystectomy and assess diagnostic accuracy.

June 27, 2026Open Access

Airway pressure reliably predicts intra-abdominal pressure during laparoscopic surgery

PSPedro Ducatti de Oliveira E SilvaInstituto de Gastroenterologia de Goiânia RMRenato Miranda de MeloInstituto de Gastroenterologia de Goiânia JFJosé Fernando Bastos FolgosiInstituto de Gastroenterologia de Goiânia

Key Points

This research aims to correlate airway pressure with intra-abdominal pressure during laparoscopic cholecystectomy and assess diagnostic accuracy.
Prospective observational cross-sectional study of ASA I–II patients undergoing elective laparoscopic cholecystectomy.
Data were collected in Brazil from 2020 to 2021, with a minimum sample size of 80 patients established.
Airway pressures were recorded at incrementally increased intra-abdominal pressures to assess correlation using a linear mixed-effects model.
PIP showed strong correlation with IAP (β = 0.439 cmH₂O/mmHg, p < 0.001) and excellent diagnostic accuracy (AUC 0.905).
PLAT showed low correlation with IAP and poor diagnostic accuracy (AUC 0.695).
Optimal cutoff for PIP was identified at 24 cmH₂O with 84.6% sensitivity and 87.2% specificity.

Abstract

Abstract Background Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are life-threatening complications increasingly recognized in the surgical setting, particularly in complex abdominal wall surgery. Bladder pressure monitoring, although the gold standard, is limited intraoperatively due to constraints related to patient positioning, contamination risk, and procedural interruption. We evaluated the correlation between intra-abdominal pressure (IAP) and airway pressure (AWP) during laparoscopic cholecystectomy and the diagnostic accuracy of AWP for detecting intraoperative IAH. Methods Prospective observational cross-sectional study in ASA I–II patients undergoing elective laparoscopic cholecystectomy at a single tertiary center, Brazil. Data were collected between 2020 and 2021. Sample size was calculated using the Fleiss method (80% power, two-sided α = 0.05, assumed r = 0.30), requiring a minimum of 80 participants. Pneumoperitoneum was increased incrementally (baseline, 5, 10, 15, 20 mmHg). PIP and PLAT were recorded at each level. A linear mixed-effects model (REML) with patient as random intercept was used as the primary correlation analysis; Pearson correlation is reported as a descriptive secondary measure. ROC analyses were performed. Results Of 95 patients assessed, 78 completed the study. Both PIP and PLAT correlated significantly with IAP ( p < 0.001). Linear mixed-effects model: PIP β = 0.439 cmH₂O/mmHg (95% CI: 0.410–0.468), p < 0.001, ICC = 0.640. PLAT β = 0.134 cmH₂O/mmHg (95% CI: 0.121–0.147), p < 0.001, ICC = 0.936. Pearson r (descriptive): PIP r = 0.670 (95% CI: 0.612–0.722); PLAT r = 0.253 (95% CI: 0.157–0.343). PIP increased by 6.99 cmH₂O at IAP 15 mmHg and 8.06 cmH₂O at IAP 20 mmHg. ROC analysis showed excellent diagnostic accuracy for PIP (AUC 0.905, 95% CI: 0.868–0.940), with an optimal cutoff of 24 cmH₂O (84.6% sensitivity, 87.2% specificity). PLAT showed poor diagnostic accuracy (AUC 0.695, 95% CI: 0.662–0.737) and is not a reliable clinical surrogate for IAP. Conclusion PIP strongly correlates with IAP and accurately detects intraoperative IAH. PLAT is not recommended as a standalone diagnostic surrogate for IAP. Airway pressure monitoring may serve as a practical, real-time screening tool during abdominal surgery, with particular promise in complex abdominal wall reconstruction.

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