Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DECUBITUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources
PubMed2000

[Effect of bronchial drainage on the improvement in gas exchange observed in ventral decubitus in ARDS].

OBJECTIVES: A bronchial secretion draining effect is frequently suggested as a mechanism for oxygenation improvement during prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS). Nevertheless, it has never really been evaluated. The aim of this study was to search for an interrelationship between the volume of the bronchial secretion and the improvement of the PaO2/FIO2 ratio during prone positioning, with NO inhalation or not. STUDY DESIGN: Open prospective clinical study. PATIENTS: The study included 15 consecutive patients with severe ARDS (PaO2/FIO2 < 200 after alveolar recruitment, Murray score > 2.5). METHODS: They were returned to the prone position for 4 hours (h0-h4) combined with an inhalation of 5 ppm NO during 1 hour (h2-h3). Tracheal suction were performed hourly between h-2 and h6 and weighed on a precision scale from h-1 to h6. Haemodynamic, blood gas and respiratory compliance were recorded at h0, h2, h3, h4 and h6. RESULTS: No significant haemodynamic changes were observed in the various phases. Compared with the baseline condition at h0, PP and PP + NO respectively improved PaO2/FIO2 by 102 +/- 62% at h2 (P < 0.005) and 156 +/- 79% at h3 (P < 0.005/h0 and < 0.01/h2). 14/15 patients responded to PP and 15/15 to PP + NO (gain in PaO2/FIO2 > 10%). Concerning secretions, we collected 3.0 +/- 7.5 g, 4.4 +/- 6.1 g, 1.7 +/- 1.4 g and 1.7 +/- 1.6 between h-2 and h0, h0 and h2, h2 and h4, h4 and h6. Individual assessments showed no relationship between the PaO2/FIO2 evolution at any time and the quantity of secretions obtained during the first 2 hours in the prone position. Six patients presented secretions of less than 1 g between h0 and h2, and for whom the improvement in oxygenation was higher than average (115 +/- 53% at h2). CONCLUSION: In patients with little or moderate secretions, the improvement observed in oxygenation, with or without NO, does not depend on their volume.

Aged↗
PubMed1997

The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral decubitus positioning.

OBJECT: This study was designed to measure changes in tracheal and bronchial lumen distances from mainstem and secondary carina with lateral positioning, and to assess whether inflation of the endobronchial cuff before lateral positioning would further secure a double-lumen endobronchial tube (DLT) and reduce movement. DESIGN: Prospective study. SETTING: University-affiliated cancer center. PARTICIPANTS: Fifty adult patients scheduled for elective thoracic surgical procedures requiring the placement of a left DLT. INTERVENTIONS: Patients were sequentially assigned to either the endobronchial cuff-inflated group or the deflated group during lateral positioning. After induction of general anesthesia, a left polyvinylchloride (PVC) DLT was placed and the position confirmed. In the supine position, the distance from the tip of the tracheal lumen to main carina was measured using a fiberoptic bronchoscope (FOB) passed through the tracheal lumen, and the distance from the bronchial lumen to secondary carina was measured with the FOB passed through the bronchial lumen. The patients were then positioned laterally and a second set of measurements taken. Overall movement was determined by increases and decreases in tracheal and bronchial distances obtained by substracting supine values from lateral values. MEASUREMENTS AND MAIN RESULTS: There was significant tracheal movement in 40 of 50 patients, with a mean of 0.92 +/- 1.0 cm. This was predominantly in the upward direction, as seen in 35 of 50 patients. There was significant bronchial movement in 37 of 50 patients, with a mean of 0.92 +/- 1.15 cm. Also, predominance in the upward direction was seen in 34 of 50 patients. CONCLUSIONS: DLTs move with lateral positioning, regardless of endobronchial cuff inflation. The movement is predominantly in the upward direction. Therefore, fiberoptic visualization in the supine position should be used only to confirm that the endobronchial lumen is placed on the appropriate side and the cuff is at least 1 cm inside the left mainstem bronchus. Final positioning should always be verified in the lateral position.

Adult↗
PubMed2000

[Study on quality assurance in the prevention and therapy of decubitus ulcer by measuring the overlay pressure with test subjects on different prophylaxis systems].

The aim of this study on quality assurance in prevention and treatment of bedsores was to analyse the current state of treatment of pressure sores at the University Hospital in Marburg. Measurements of pressure exerted on the skin were taken of six soft storage systems and five alternating pressure systems. In addition, the study aimed to find out whether the applied method of pneumatic pressure measurement could be used with patients in every day nursing and whether reliable and valid data could be generated from patients who have already developed bedsores. In order to answer these questions measurements were taken on 23/19 patients, including patients in lateral position, placing measuring instruments between the mattress/bed system and the body. The soft storage systems results prove a significant pressure reduction at all measuring points (p < 0.05), at the os coccygis even a highly significant pressure reduction (p < 0.01). The alternating pressure systems results show that the average maximum pressure over 12 min lies between 56.39 mmHg and 38.94 mmHg with differing amplitudes (75.47 mmHg-5 mmHg) and alternating frequency (1.5 min-10 min).

Humans↗
PubMed2003

[Prevention of decubitus ulcer: theory and practice].

In Spring 2001, the Department of Nursing Science, Humboldt-University in Berlin, conducted a pressure ulcer prevalence study on 3012 patients of eleven hospitals. The investigation revealed the use of pressure ulcer prevention on patients with different stages, or without a pressure ulcer. The study also focused on the use of interventions and bed-aids on patients both at risk and not at risk. Interventions without the use of bed-aids were used more often than interventions using bed-aids. The main type of intervention used was the mobilisation of the patient. This was found in all groups (at risk or not at risk; with or without a pressure ulcer). The bed-aids which were most frequently used were pressure-relieving cushions and heel-protectors. Because of the differences in pressure ulcer management among the hospitals, this article also shows evidence on bed-aids and the interventions as known from literature. In four of the interventions as used in practice, the highest degree of evidence could be found. However, in five cases no evidence could be found at all. The comparison of the use in practice and the literature revealed that interventions which are often used as pressure reduction are well tested and can be recommended. However, the (sheep-) skins, which are frequently used, are not reducing the pressure significantly.

Aged↗
PubMed1988

Biochemical changes in skin composition in spinal cord injury: a possible contribution to decubitus ulcers.

Patients with spinal cord injury (SCI) have an increased susceptibility to ulcers of the skin due to pressure. Immediately after the injury, SCI patients have a greatly increased degradation of collagen from both bone and skin. Loss of collagen from the skin could account for a reduction of the skin's ability to resist mechanical insults. This paper describes the results of an investigation into the role of collagen metabolism in the etiology of pressure ulcers. Skin biopsies have been obtained from healthy non-paralysed volunteers, and from insensitive and sensitive skin in SCI patients. The amino acid content of the insensitive skin was considerably lower than in sensitive skin. The activity of the enzyme lysyl hydroxylase was also lower in the insensitive skin. Lysyl hydroxylase activity in the sensitive skin was similar to enzyme activity in control skin biopsies of the same body area.

Amino Acids↗
PubMed2000

[Decubitus ulcer in the terminal phase: epidemiologic, medicolegal and ethical aspects].

BACKGROUND AND OBJECTIVES: Pressure sores usually result from insufficient preventive measures. They are particularly omnipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the significance of the nursing environment. PATIENTS AND METHODS: The prevalence of pressure sores among the dead was analysed in a prospective cross-sectional study based on 10,222 postmortem examinations in a crematorium in Hamburg. RESULTS: The overall prevalence of pressure sores from grades I to IV was 11.2% (grade I: 6.1%, grade II: 3%, grade III: 1.1%, grade IV: 0.9%). A final logistic regression model showed that pressure sores of Grade III or IV were associated with female gender, date of death in the summer, marasmus, stroke history, neurological disease in general, kidney disease, preceding traumatic events and nursery home residence at the time of death. More than half of all the grade IV cases were diagnosed among nursing home residents whereas those who had died in hospitals contributed to only 11.5% of all the grade IV cases (dead from private homes 34.4%). Nursing home residence was associated with female gender, marasmus and stroke history which predisposed to a higher rate of pressure sores. CONCLUSIONS: Nursing homes are confronted with the highest proportion of pressure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure sores point to the shortfalls in the present public health sector and nursing home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assessment of high-grade pressure sores should also take ethical considerations into account when considering maximum therapy goals among dying persons.

Aged↗