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At least 451 records · Page 25Linked to original sources
PubMed1992

[Continuously alternating prone and supine positioning in acute lung failure].

Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. Furthermore different studies have shown the effects of supine and lateral decubitus posture in patients with acute respiratory failure. There are only rare reports on using the prone position, which doesn't require two-lung ventilation in difference to lateral position. We have studied 16 patients with acute respiratory failure by using continuous changing between prone and supine position under mechanical ventilation. All were male, aged 41.3 years in the middle and showed an average "Injury Severity Score" of 30 (13-50). 15 were trauma patients with blunt chest trauma in 11 cases. We have used prone position on threatening or manifest ARDS. In all patients we observed an increment of PaO2 during prone position on to 48 mmHg so that FiO2 could be reduced on an average of 0.2 within the first 48 h since changing patient's position. Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Unexpected air embolism during an aneurysmal operation in supine position--a case report and a speculation about its pathogenesis].

The occurrence of air embolism in supine position operation is extremely rare. We reported a case of air embolism during the operation of a ruptured middle cerebral artery aneurysm in supine position. A 58-year-old woman was admitted to our hospital in semicomatous state. A CT scan revealed diffuse subarachnoid hemorrhage. Cerebral angiogram showed a middle cerebral artery aneurysm. Massive pinkish foamy sputum and butterfly shadow on chest x-ray strongly suggested an association of neurogenic pulmonary edema (NPE). Barbiturate therapy and controlled ventilation with positive end-expiratory pressure (5cmH2O) were started. Her airway pressure was about 35cmH2O. Decrease of pinkish foamy sputum and an improvement of chest x-ray findings on the next day encouraged us to perform a clipping operation. Just before a clip application, air bubbles were observed to pass through the middle cerebral artery under the microscope. Subsequently cardiac standstill was brought out. Fortunately, she was resuscitated, and a clip application was finished. A postoperative CT scan revealed an infarction in the middle cerebral artery area. A postoperative cerebral angiogram showed occlusion of a temporal branch of the right middle cerebral artery, P1 portion of the left posterior cerebral artery, and the right superior cerebellar artery. We speculated that high endotracheal pressure brought out pulmonary alveolar rupture, and in spite of supine position operation massive air, which flowed into systemic circulation from ruptured alveoli, caused cerebral infarction and cardiac arrest. We consider that unrecognized air embolism might be the one of the factors influencing the prognosis of severe subarachnoid hemorrhage, especially in the cases associated with neurogenic pulmonary edema.

Embolism, Air↗
PubMed2005

Prone versus supine position in mechanically ventilated children: a pilot study.

BACKGROUND: It is known that mechanically ventilated patients in the prone position have improved oxygenation compared with those supine. We did a prospective, randomized, controlled trial to evaluate the effect of prone position during mechanical ventilation, on survival in critically ill children. MATERIAL/METHODS: Forty-two children needing mechanical ventilation for various illnesses were randomized to receive initial ventilation for four hours prone or supine by drawing lots. Initial severity of illness and blood gases in all children were noted. In a crossover design, after the initial four hours the children were turned over and ventilated in the alternate posture for an hour. Oxygenation parameters and mean airway pressures were noted at one hour, four hours, and five hours. Mortality, duration of ventilation, and the above parameters were compared in the two groups. RESULTS: Initial PRISM scores were similar in the two groups. Mortality in the prone group was less than in the supine group. The odds ratio of mortality was 0.20 (95% CI 0.05-0.75). Duration of ventilation was similar in the two groups. The oxygenation index was significantly lower in the prone group at one, four, and five hours after onset of ventilation. CONCLUSIONS: Prone position in the first few hours of ventilation significantly improves gas exchange and oxygenation, reduces the mean airway pressures required to ventilate children, and may cause significant improvement in survival. Our study protocol allowed ventilator settings to be changed as needed during ventilation.

Child, Preschool↗
PubMed2006

Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives.

CONTEXT: Clinically preferred maternal position during childbirth has varied between supine and nonsupine over time and from patient to patient. Preferred maternal birthing position is coming under increasing scrutiny. OBJECTIVE: To compare postpartum maternal and infant outcomes resulting from supine and nonsupine positions maintained during the second stage of labor. DESIGN AND METHODS: Nonrandomized clinical trial comparing low-risk women (N=198) in two separate obstetrics practices. In one practice, parturients (n=100) used only the supine position as their birthing position. In the other practice, parturients (n=98) used any or all of three nonsupine positions (sitting, squatting, or kneeling/hands-and-knees). Data collection took place immediately after birth by provider survey and included: Apgar scores, demographics, estimated blood loss, neonatal weight, perineal integrity, position during second-stage labor and birth, and vulvar edema. RESULTS: Infants born to mothers in nonsupine positions were delivered with significantly less tearing of the perineum (P<.001) and less vulvar edema (P<.001). Although the length of second-stage labor was shorter among the women who were nonsupine, this result lacked statistical significance. There did not appear to be increased risk to the infant from the mother's nonsupine posture. CONCLUSION: Nonsupine positions during labor and delivery were found to have clinical advantages without risk to mother or infant. Enhanced maternal outcomes included improved perineal integrity, less vulvar edema, and less blood loss.

Delivery, Obstetric↗
PubMed2006

Diagnosis of ischaemic heart disease by myocardial contrast echocardiography during supine bicycle stress.

INTRODUCTION: Myocardial contrast echocardiography (MCE) is a new imaging modality for diagnosing ischaemic heart disease (IHD). AIM: The aim of this study was to assess 1) the feasibility of MCE during supine bicycle stress and 2) the value of this method in the diagnosis of IHD. METHODS: Supine bicycle stress was performed in 44 consecutive patients (pts) referred for coronary angiography with an intermediate pre-test probability of IHD. MCE was carried out at peak stress and during recovery (once the heart rate returned to the pre-exercise value). During MCE an ultrasound contrast agent (Sonovue) was administered intravenously in a continuous mode using an infusion pump (BR-INF 100, Bracco Research). The acquired images were qualitatively assessed for perfusion and wall motion abnormalities. The 18-segment division of the left ventricle was used in the analysis. Coronary angiography was performed in all pts within 15 days of the exercise test. A quantitative analysis of coronary artery stenoses was carried out using the CAAS system. RESULTS: MCE could not be performed in 2 pts due to technical difficulties. Coronary angiography revealed significant coronary artery stenosis in 25 pts. The sensitivity and specificity of MCE in the diagnosis of IHD were 92.0% and 82.4%, respectively. The positive and negative predictive values were found to be 88.5% and 87.5%, respectively, while the agreement between coronary angiography and MCE was 88.1% (kappa=0.75). CONCLUSIONS: MCE during supine bicycle stress and continuous intravenous administration of an ultrasound contrast agent is a feasible technique and allows accurate diagnosis of IHD in pts in whom the pre-test probability of the disease is intermediate.

Adult↗
PubMed2006

[Pulmonary atelectasis in patients with neurological or muscular disease; gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position].

We report 10 cases of pulmonary atelectasis diagnosed by chest computed tomography in patients with neurological or muscular disease. Atelectasis was frequently seen in hypotonic patients who could not roll over on their own. The atelectases located mostly in the dorsal bronchopulmonary segments, adjacent to the heart or diaphragm. Atelectasis diminished in two patients after they became able to roll themselves over. Gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position can cause pulmonary atelectasis in patients with neurological or muscular disease who can not roll over by their own power. To confirm that the prone position reduces compression of the lungs, chest computed tomography was performed in both the supine and the prone position in three patients. Sagittal images with three-dimensional computed tomographic reconstruction revealed significant sternad displacements of the heart and caudal displacements of the dorsal portion of the diaphragm on prone position compared with supine position. The prone position, motor exercises for rolling over, and biphasic cuirass ventilation are effective in reducing gravity-related lung compression. Some patients with intellectual disabilities were also able to cooperate in chest physiotherapy. Chest physiotherapy is useful in preventing atelectasis in patients with neurological or muscular disease.

Abdomen↗
PubMed1991

Effects of maternal postural change from supine to left-lateral on tocolysis, maternal cardiac function and pulsatility index of uterine artery.

In order to prove the usefulness of the left-lateral position (l-lat.) in preventing the cardiovascular complications associated with ritodrine, twenty-nine patients having preterm labor were employed as the subjects of this study. Before and during the administration of ritodrine, the cardiac function was recorded by impedance cardiography. (1) When ritodrine was administered in the supine position, SV and CO first increased but eventually tended to decrease. When the position was changed to the l-lat. after SV and CO had almost returned to the preadministration level, HR decreased and SV and CO increased in 70% (10/14) of the patients. However, in patients showing no change in HR in the supine position, the cardiac function did not change either. (2) The magnitude of the changes in cardiac function accompanying the postural change during ritodrine administration was compared with that observed before administration. The decrease in HR and the increase in SV due to the postural change to the l-lat. were larger during ritodrine administration than before administration. The l-lat. position is recommended as a means for preventing the side effects accompanying ritodrine administration. This study also indicated the possibility that the inferior vena cava may be more strongly compressed in the supine position by the relaxed gravid uterus.

Cardiac Output↗
PubMed1991

Partitioning of small and large saline loads in supine and head-up tilted dogs.

A previous study from our laboratory has demonstrated that acute saline loading in supine anaesthetized dogs (7% body weight) is associated with significant protein efflux from the intravascular compartment, and a smaller retention of infusate than would be predicted from theoretical considerations. The advent of postural stresses (quadruped and 45 degrees head-up tilt positions) aggravate this phenomenon. In the present study 'small' (3.5% BW) and 'large' (15% BW) saline loads were administered to supine and tilted anaesthetized dogs. In supine dogs, the 3.5% load was associated with a 22.8% reduction in circulating protein (TIP) and 14.6% retention of the infusate (increased from 10.9% in 7% BW loading), while 15% BW loading was associated with only a 4.3% retention of infusate and 47% reduction in TIP (p less than 0.05). When dogs were tilted, the 3.5% group retained zero infusate and the reduction in TIP rose to 43.6%. In the 15% group, 2.6% of the infusate was retained even though a 56.8% reduction of TIP was observed. We conclude that retention of isotonic infusate is most efficient when transcapillary protein efflux is limited. With very large degrees of volume loading, tilted animals will retain more infusate than dogs receiving a small load, presumably because the increased rate of infusion matches the vascular fluid losses.

Anesthesia↗
PubMedDate not supplied

Dorsally angulated solitary metaphyseal greenstick fractures in the distal radius: results after immobilization in pronated, neutral, and supinated position.

In a prospective study, angular redisplacement has been correlated with immobilization in the pronated, neutral, or supinated position (20 children in each group). Those with greater than 20 degrees of dorsal angulation at day 1 and after 2 weeks were manipulated. Dorsal angulation after immobilization at day 1, 2 weeks, and 6 weeks was measured on accurate lateral views. Angular displacement during the first two weeks was (a) greater among reduced than unreduced cases in the pronation group (p less than 0.001), and (b) less in the supination group than in the other groups (p less than 0.05). Based on these findings, we believe that the fracture should be immobilized in the supinated position.

Child↗
PubMedDate not supplied

Comparisons of cardiac output in supine and lateral positions.

Cardiac output was measured by thermodilution in 51 adult postcardiac surgical patients using three positions, supine, right lateral, and left lateral, each with 20 degrees backrest elevation. Measurements were taken 4 to 24 hours (M = 10.58) after surgery. Mean cardiac output was significantly different in the three positions, p = .03. This difference resulted from changes in stroke volume, p = .004, rather than changes in heart rate, p = .12. The largest variation occurred between cardiac outputs measured in the supine position and those measured in the left lateral position. Patients at greatest risk for variations in cardiac output with lateral postural change were those with a cardiac index less than 2.3 L/min/m2, those in whom the time elapsed since surgery was less than 12 hours, and those receiving either vasoactive drugs or mechanical ventilation. These results suggest that nurses need to measure cardiac output using a supine position to control for physiological changes that may occur with lateral postural change.

Adult↗
PubMed1995

Laparoscopic sterilization in the supine position using the Ramathibodi uterine manipulator.

OBJECTIVES: To investigate the usefulness of the Ramathibodi uterine manipulator (AMZURA Enterprises, Freeport, NY) in performing laparoscopic sterilization procedures in the supine position under local anesthesia. DESIGN: Descriptive prospective study. SETTING: Ambulatory surgical unit of university-affiliated hospital. PATIENTS: Women presenting for elective sterilization and weighing < 110 kg. INTERVENTION: The Ramathibodi uterine manipulator was used to provide uterine manipulation in 85 cases of laparoscopic sterilization, all performed in the supine position as local anesthesia-sedation sterilization operations. Because such procedures are becoming more common worldwide, we propose the acronym "LASSO" (Local Anesthesia-Sedation Sterilization Operation) for this class of operations. Although commonly used in minilaparotomy procedures, use of this uterine manipulation device in laparoscopic procedures has not been published previously. MAIN OUTCOME MEASURE: Successful tubal occlusion. RESULTS: Among the 85 cases reported here there were no failures to manipulate the uterus successfully, to identify the tubes, and to occlude them. CONCLUSIONS: The simplicity of the Ramathibodi uterine manipulator provided several advantages over other means of uterine manipulation, notably [1] constant easy-to-learn maneuvers, [2] no tenaculum or balloon requirement, [3] the procedure could be performed in the supine position, and [4] there are no working parts, screws, or springs that could be lost or broken by operating room staff. Our experience with this device leads us to recommend it to colleagues as an inexpensive, safe, and effective alternative to currently available instruments for providing uterine elevation during laparoscopic sterilization procedures.

Anesthesia, Local↗
PubMed1995

Exercise prescription for sitting and supine exercise in subjects with quadriplegia.

Although in able-bodied individuals heart rate (HR) indicates exercise intensity, the linearity of the HR/oxygen uptake (VO2) relationship has not been established in persons with quadriplegia with impaired sympathetic function. The HR/VO2 relationship and four ACSM recommended methods of exercise prescription were evaluated in 11 individuals with quadriplegia during intermittent progressive peak exercise tests. Tests were conducted in either a supine or sitting position using an arm ergometer. The HR response was highly variable, with HR/VO2 correlation coefficients ranging from 0.22 to 0.99. A 2 x 2 ANOVA revealed an interaction between injury level, high-level (above C7) vs low-level (C7 and below) and exercise position, with the high-level group exhibiting the lower coefficient (0.68) between the HR/VO2 relationship in the sitting position. For all subjects, the target of 55-90% peak HR (mean = 72.5%) corresponded to 34% peak power output (PO) in sitting and 44% peak PO in supine. Similarly, 70% peak VO2 corresponded to 46% and 50% of peak PO (sitting and supine, respectively). A rating of perceived exertion (RPE) of 10-12 corresponded to 50-60% peak PO and was associated with a higher PO than that predicted by the HR or VO2 methods. The results of this study indicate that exercise intensity for quadriplegics be based on 50-60% peak PO and/or an RPE of 10-12.

Adult↗
PubMedDate not supplied

[Repair of a vesicovaginal fistula in the ventral supine position (34 cases)].

The authors report the efficacy of a transvaginal approach in the ventral supine position for repair of vesicovaginal fistula based on a series of 34 consecutive patients. 34 patients, between the ages of 15 and 60 years, with vesicovaginal fistula (cervicotrigonal in one half of cases) of obstetric origin (73% of dystocia) in multiparous women (62% were treated by transvaginal closure of the fistula in the ventral supine position). 29 complete successes were obtained with 5 residual fistulae which were lost to follow-up. The use of the ventral supine position is valuable in the transvaginal repair of vesicovaginal fistulae.

Adolescent↗
PubMed1994

[Attenuation effects in 99mTc-MIBI stressed myocardium 360 degree SPECT: a comparison of the supine and prone positions].

Due to the higher photon energy of 99mTc as compared to 201Tl attenuation effects are expected to be less prominent in SPECT imaging using 99mTc-labelled isonitriles. Reduced 99mTc-MIBI uptake has been observed especially in male patients despite low probability of coronary artery disease. 56 patients were investigated in prone and supine position after bicycle exercise. Inclusion criterium was the identical location of the ROI with maximal tracer uptake in prone and supine imaging. In prone position 99mTc-MIBI uptake was significantly higher in the posterior wall as compared to supine imaging (p < .001). The underlying cause of the apparent increase in tracer uptake of the posterior wall was a decrease in count density in the region of maximal uptake (p < .01) while the count densities in the posterior wall were unchanged (p = NS). Relative uptake values in apical and septal regions of the anterior wall significantly decreased in prone imaging. SPECT imaging in prone position is useful in minimizing attenuation artifacts. However, because a deterioration in the anterior wall cannot be excluded, studies that compare the sensitivities and specificities for the different coronary arteries are required before general prone imaging can be recommended.

Adult↗
PubMed1996

Threshold values for supine and standing Cobb angles and rib hump measurements: prognostic factors for scoliosis.

Seven parameters recorded at the first clinical examination of 326 growing scoliotic patients were correlated with the speed of progression of the scoliotic curve during a natural history survey period. The parameters were: age; bone age (according to Greulich and Pyle); pubertal and Risser stage; curve shape; rib hump, measured in forward bending in a sitting patient and supine and standing radiographic Cobb angles of the scoliotic curve. The speed of progression of the scoliotic curve was expressed as the annual increase in Cobb angle. It was quantified graphically after plotting the measurements taken from all the radiographic examinations made during the survey. The survey period ranged from 6 months to several years, depending on the rate of progression. It was 6 months only if the scoliotic curve demonstrated worsening of more than 3 degrees at two successive examinations performed at least 3 months apart. The authors aimed to identify the minimum values of curve angle and rib hump, identified at first examination in 95-100% of patients whose parameters at follow-up were above these values (supine angle: 17 degrees; standing angle: 24 degrees; rib hump: 11 mm), therefore demonstrating curve worsening. Then, they analysed how the other parameters such as age, bone age, state of maturation and curve shape influenced these threshold values of rib hump and supine and standing angles. The authors present the threshold values for the whole sample according to the sexual state of maturation and also for each curve shape. They demonstrate that a combination of states of maturation, several measures of the scoliotic curve and curve shape provides the best basis for individual prognosis.

Age Factors↗
PubMed1987

Haemodynamic and blood gas changes in buffaloes (Bubalus bubalis) in the supine position following thiopentone anaesthesia with premedication.

Studies were undertaken on seven adult female buffaloes (Bubalus bubalis) premedicated with triflupromazine hydrochloride (0.3 mg/kg) and chloral hydrate (30 mg/kg). Anaesthesia was induced with thiopentone sodium (10 mg/kg) and animals were kept under intermittent positive pressure ventilation. Measurements were made for 30 min in the lateral position, for 20 min in the supine position and subsequently for 40 min again in the lateral position. Regurgitation during anaesthesia was avoided by evacuation of the rumen by rumenotomy two days prior to the experiment. When animals were in the lateral position there were minimal changes in arterial pressure and heart rate but central venous pressure rose. These changes were related to intermittent positive pressure ventilation. In the supine position, increase in heart rate (28%) was associated with profound hypotension (56%) and decrease in central venous pressure (171%) in these animals. There was a fall in venous oxygen tension and a marked increase (91%) in oxygen extraction ratio. Restoration to the lateral position ameliorated all these changes rapidly. It was suggested that a 'low pressure-low flow' circulatory state exists in anaesthetised adult buffaloes in the supine position.

Anesthesia↗
PubMed1978

[Contribution of the biceps brachii and pronator teres muscles to the efforts of pronation or supination. II. dynamic work (author's transl)].

The electrical activity of the biceps brachii and pronator teres muscles is studied through the prono-supination of the forearm in some anisometrical conditions (dynamic work) when the inertia of the mobile system and the elbow position are being varied. The subjects are required to perform pronation, supination and flexion movements, either isolated or combined. From the findings obtained when the integrated electrical activity (Q) is related to the mechanical work (W), one can conclude that a. the Q-W linear relationship seems to characterize the chief function of a muscle, b. the slope of the Q-W relationship depends on the elbow position, c. the pronator muscles do not inhibit in a selective manner the biceps supinating function. So a bifunctional muscle seems to act as a whole.

Biomechanical Phenomena↗
PubMed1985

Supination-eversion ankle fractures sustained during down-hill skiing.

Two cases of supination-eversion grade II ankle fractures are presented. Both fractures were sustained during downhill skiing and both patients were wearing competition ski-boots with all buckles closed. The trauma mechanism is discussed. The only force that can act upon an ankle inside a ski-boot is a torsion of the calf on the foot. It is, therefore, interesting that the supination-eversion-type fracture can be reproduced with this violence. By considering the ankle and the subtalus joints as a torsion transmitter it can be shown that a supination leads to similar forces between the talus and the mortise as does an outward rotation of the foot. This explains why the two different trauma mechanisms lead to the same injury.

Adult↗