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At least 217 records · Page 12Linked to original sources
PubMed1990

Decubitus ulcers. How to prevent them--and intervene should prevention fail.

Decubitus ulcers can develop in any chronically ill patient who is immobilized. Elderly patients and patients with spinal cord injury are at particularly high risk. Prevention is best achieved by identification of susceptible patients, alleviation of causative and predisposing factors, and early detection of ischemic skin changes. Treatment should be determined by the depth of tissue involvement. Conservative therapy is effective for shallow ulcers, whereas surgery, including the use of flaps, is reserved for deeper, more extensive lesions.

Humans↗
PubMed1989

Lung function in the supine and lateral decubitus positions in anaesthetized infants and children.

We have measured dynamic lung compliance or static lung thorax compliance, functional residual capacity (FRC), and two indices of pulmonary gas mixing (pulmonary clearance delay (PCD) and single breath alveolar mixing efficiency (SBAME)) in 25 children in the supine and lateral decubitus position during nitrous oxide-halothane anaesthesia. Fifteen children (5 month-8 yr) breathed spontaneously and 10 (4 month-9 yr) underwent mechanical ventilation. Tidal volume and rate of ventilation were, respectively, 3.5-6.6 ml kg-1 and 22-46 b.p.m. in spontaneously breathing supine children, and 8.3-15 ml kg-1 and 20-30 b.p.m. in mechanically ventilated supine children, and did not differ significantly in the lateral position. There was no significant change in compliance when the child was turned to the lateral position, but FRC increased from 22 (SD7) to 25 (8) ml kg-1 (P less than 0.01) in the spontaneously breathing group and from 19 (6) to 24 (8) ml kg-1 (P less than 0.01) in the other group. In spontaneously breathing children, PCD and SBAME indicated a somewhat impaired pulmonary gas mixing (P less than 0.05) after the child had been turned to the lateral position, but no change occurred in the other group. These findings suggest that the distribution of ventilation in anaesthetized children in the lateral position is similar to that reported previously in anaesthetized adults.

Anesthesia↗
PubMed2005

Intubating laryngeal mask for airway management in lateral decubitus state: comparative study of right and left lateral positions.

BACKGROUND: The intubating laryngeal mask has been used for the emergency management of the airway in patients placed in the lateral decubitus position. We have conducted this prospective study to compare the feasibility of placement of an intubating laryngeal mask and blind tracheal intubation guided by the intubating laryngeal mask in patients placed in the right and the left lateral positions. METHODS: A total of 82 adults of both sexes with normal airways, scheduled for cholecystectomy, were allocated randomly to be placed in either the right (n=41) or left (n=41) lateral position for the insertion of an intubating laryngeal mask and blind tracheal intubation guided by the intubating laryngeal mask under balanced general anaesthesia. A sequence of standard manoeuvres was performed after each failed attempt at intubating laryngeal mask placement and intubation. RESULTS: The intubating laryngeal mask was placed in all patients at the first attempt. Ventilation of the lungs through the intubating laryngeal mask was possible in 40 patients (97.5%) from each group after the first attempt at insertion (P=1). Following adjustments, adequate ventilation could be achieved in all patients. The first attempt success rates of blind tracheal intubation were 85.3% (35/41) and 87.8% (36/41) in the right and left lateral groups, respectively (P=1). The remaining patients from both groups (except for one patient in the left lateral group who had a failed intubation) were intubated at the second attempt. CONCLUSION: Insertion of the intubating laryngeal mask and blind tracheal intubation through it in the lateral position is feasible in patients with normal airways. These procedures have a high and comparable success rate when patients are placed in the right and left lateral positions.

Adult↗
PubMed1990

The role of alternating air and Silicore overlays in preventing decubitus ulcers.

Patients with chronic neurological diseases who were at high risk of decubitus ulcers were randomly assigned to alternating air on silicore mattress overlays for a period of 3 months. Of 148 subjects who completed the trial, more than 50% in each group developed one or more ulcers. No statistically significant differences between groups were found in the incidence, severity, healing duration or the location of the ulcers; with the exception of a significant difference (p less than 0.001) in the categorical location of the trochanters.

Adolescent↗
PubMedDate not supplied

Ipsilateral decubitus position for percutaneous CT-guided adrenal biopsy.

Positioning the patient on the side to be biopsied elevates and relatively immobilizes the diaphragmatic leaf on the dependent side, allowing percutaneous adrenal needle biopsy by a direct posterior approach without traversing lung tissue. The ipsilateral decubitus position was used successfully for biopsy of four small adrenal lesions in which lung precluded a direct posterior approach in the prone position. In addition, the relative stability of the diaphragmatic leaf further facilitated accurate needle placement.

Adrenal Gland Diseases↗
PubMed1976

The management of decubitus ulcers by muscle transposition. An 8-year review.

Our 8-year experience with the management of decubitus ulcers by means of muscle transposition and skin cover is reviewed. The role of infection and its management are discussed. Some modifications of our previous techniques and newer operative approaches are detailed. Our complications and follow-up results are presented.

Bacterial Infections↗
PubMed1980

Primary closure of trochanteric decubitus ulcers: the bipedicle tensor fascia lata musculocutaneous flap.

A surgical procedure is described for the definitive treatment of trochanteric decubitus ulcers. It combines the advantages of the bipedicle skin flap and the musculocutaneous flap; that is, a large area of skin is provided with a thick protective padding consisting of fat, fascia, and muscle richly vascularized by the musculocutaneous perforating circulation. The disadvantages of either flap alone (i.e., dependence on dermal blood supply and skin grafting of the donor bed) are avoided. In patients who are traditionally the most difficult nursing problems, this one-stage reconstructive procedure results in shorter operating room time, easier postoperative care, shorter hospital convalescence, and an enduring protection against recurrent trochanteric pressure problems.

Fascia↗
PubMed1984

Bilobed latissimus dorsi flap for a decubitus ulcer.

A case is presented of a bilobed latissimus dorsi flap. The advantage of this flap is to close a large defect without having to resort to a skin graft for closure of the donor-site defect. The advantages of this procedure are as follows: Well-vascularized, stable coverage for decubitus ulcers. Acceptable cosmetic deformity. Avoidance of a skin graft. Decreasing the length of hospitalization.

Aged↗
PubMedDate not supplied

Relationship of spine deformity and pelvic obliquity on sitting pressure distributions and decubitus ulceration.

The distribution of pressure points in 16 patients with paraplegia, nine with ulcers, and six who were ulcer free were compared with the distribution in 15 normal individuals using an instrument capable of simultaneously measuring multiple pressure points under the buttocks and thighs. The nine patients with ischial and sacral decubiti showed redistribution of their sitting pressures posteriorly, asymmetrical loading of the ischiae, and higher than normal pressures under the sacrococcygeum. These abnormal pressures were associated with unbalanced scoliosis, pelvic obliquity, and the loss of physiological lordosis following a spinal fusion. We defined four criteria of risk for decubitus ulceration.

Buttocks↗
PubMed1987

Unilateral pulmonary oedema/atelectasis in the lateral decubitus position.

An obese male patient developed hypoxia, hyercarbia and radiological signs of pulmonary oedema/atelectasis in the dependent lung after surgery in the lateral decubitus position. This appears to have been due to ventilation-perfusion mismatch, although other factors were considered. The patient recovered following 36 hours of intermittent positive pressure ventilation of the lungs.

Humans↗
PubMed2005

Radial nerve injury after general anaesthesia in the lateral decubitus position.

A 43-year-old female patient underwent pyelolithotomy in the left lateral decubitus position. Her upper right arm was placed on a padded armboard. Surgery lasted for 240 min. Postoperatively, she complained of numbness of the dorsal part of her right hand and wrist drop. Neurological examination revealed hypoaesthesia of the dermatome of the right forearm and hand innervated by the radial nerve. Electromyography revealed advanced axonal degeneration of the radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B and physiotherapy was started. Her symptoms improved gradually and at the 60th postoperative day, motor weakness had completely resolved. In order to prevent peri-operative nerve injury, careful positioning of every patient on the operating table with proper padding is essential, with attention paid to time-dependent risks. If an injury occurs, diagnosis and treatment should be started as rapidly as possible.

Adult↗
PubMed1982

Decubitus ulcers and rehabilitation medicine.

The approach to management of decubitus ulcers is challenging and complex. Management should be targeted to prevention. Many factors will influence the development of ulcers and their healing. These factors include physiologic as well as sociologic elements. The physician's approach must be to consider all potential contributing factors and to translate these into an appropriate program of prevention and education and treatment where necessary. The treatment program should be based on physiologic principles, but should also take into account the full patient and his psycho-social emotional needs. Patient cooperation is very important. With good medical care and full cooperation of the patient, management can achieve a healed wound and a restored patient. If either of these elements are not present, the complications may include chronic local infection with abscess formation, osteomyelitis, sepsis, amyloidosis, and death.

Anemia↗
PubMed1991

Topical metronidazole gel. The bacteriology of decubitus ulcers.

Ten putrid-smelling decubitus ulcers were successfully treated with metronidazole gel. Anaerobes were cultured from five ulcers and Wood's light examination was positive in four ulcers before treatment. The odor was eliminated after 36 hours of therapy. All results of post-treatment cultures of anaerobes and Wood's light examinations were negative.

Administration, Topical↗
PubMed1969

ACTH and decubitus ulceration: an experimental study.

1. Ulcers due to neurectomy with excision of the sciatic nerve are more severe than those due to tenotomy and can be inhibited by a single dose of ACTH.2. Timing and mode of administration of ACTH to prevent decubitus ulceration is critical and depends on its ability to prevent the separation of endothelial cells.

Adrenocorticotropic Hormone↗
PubMed1975

A small pliable humidity sensor, with special reference to the prevention of decubitus ulcers.

In an investigation of some of the external causes of decubitus ulcer, a small flexible sensor has been developed as a clinical device to measure the relative humidity (RH) of the environment between the patient and the surface on which he lies. The sensor (described in detail) can indicate RH in the range of 20 to 90 per cent by a color-matching method (chemically impregnated circles); accuracy is within 5 to 10 percent. In a preliminary study on 28 patients, the readings showed that RH was higher in the sacral region than in the scapular region, and higher for patients who were inactive than for those who were active. The device was well accepted by both patients and nurses.

Dermatology↗