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PubMed1999

The value of inspiratory-expiratory lateral decubitus views in the diagnosis of small pleural effusions.

AIM: To evaluate the usefulness of expiratory lateral decubitus views in the radiological diagnosis of small pleural effusions. MATERIALS AND METHODS: Patients referred for abdominal sonography for various reasons were examined for ultrasonographic features of pleural effusion. From November 1994 until May 1996, 36 patients were found to have pleural effusion not exceeding 15 mm in depth and were included in the study. Erect posteroanterior, lateral, and lateral decubitus (in inspiration and expiration) ragiographs were performed in all patients. RESULTS: The mean thickness of fluid was 4.3 mm on inspiratory lateral decubitus radiographs and 7.9 mm on expiratory lateral decubitus views (P < 0.005). In 31 of 36 patients (86%) there was a difference in the thickness of the fluid layer as measured in expiratory vs. inspiratory lateral decubitus radiographs. In 16% of patients, the fluid was not visible on inspiratory lateral decubitus projections. CONCLUSIONS: Expiratory lateral decubitus views may be useful for demonstrating small pleural effusions.

Adult↗
PubMed1994

Influence of duration of lateral decubitus on the spread of hyperbaric tetracaine during spinal anesthesia: a prospective time-response study.

Searching for a differential spinal block between dependent and nondependent sides, we evaluated a prospective randomized time-response study of the influence of the duration of lateral decubitus on the spread of hyperbaric local anesthetic solution during spinal anesthesia in 60 patients undergoing lower limb surgery. In a lateral position with the operated side dependent, all patients received 12 mg of lyophilized tetracaine with 0.2 mg epinephrine in 2.5 mL 10% dextrose and were randomized into four groups according to the duration of lateral decubitus after spinal injection: Group 0, patients immediately turned supine after spinal injection; Group 6, 6 min in lateral decubitus then supine; Group 12, 12 min in lateral decubitus then supine; Group 18, 18 min in lateral decubitus then supine. There was no difference in maximum sensory level between both sides in the same group nor between the four groups. In all four groups a comparable number of patients had a Grade 4 motor block on the dependent as well as on the nondependent side. A positive correlation found between duration of lateral decubitus and duration of sensory block on the dependent side suggested a preferential spread of hyperbaric local anesthetics. This differential spread was confirmed by the positive correlation between the duration of lateral decubitus and the difference in duration between dependent and nondependent sides of both sensory and motor blocks. However, because of the minimal differences between groups, we believe there is no reason to routinely maintain patients in the lateral position after performing spinal anesthesia.

Adult↗
PubMed1998

Effect of rolling bed on decubitus in bedridden nursing home patients.

Decubitus is one of the most difficult management problems encountered in bedridden elderly patients. Relief of pressure over decubitus is the most important principle of the management. We developed a rolling air cushion bed which turns the patient to a 15-degree inclined lateral position with an inflating ripple mattress, a longitudinally aligned air inflatable tube. The position of the patients was changed between right and left laterals and to supine every 15 minutes automatically. Nineteen bedridden patients with decubitus used the rolling air cushion bed for 3 months and 12 bedridden patients with decubitus used a conventional bed and had their position changes every 2 hours by care givers. Severity of decubitus was divided into 4 grades and the decubitus significantly improved from 2.8 (S.E. 0.2) to 2.0 (S.E. 0.3) after 3 months in patients using the rolling air cushion bed, while in patients with conventional beds it changed from 3.0 (S.E. 0.2) to 3.2 (S.E. 0.2) (not statistically significant). We suggest that the rolling air cushion bed would be beneficial to decubitus relief in bedridden elderly and may relieve labor by care givers.

Aged↗
PubMed1997

[Nutritional status of patients with decubitus ulcers, and changes in the skin blood flow when the sacral region was compressed].

We studied the relationship between decubitus ulcers and changes in skin blood flow with respect to the presence or absence of a decompression medium. We also studied the relationship between decubitus ulcers and the results of biochemical tests that reflect nutritional status. Two groups of inpatients with decubitus ulcers in areas other than the sacral region were studied: One used cloth diapers and the other used paper diapers. Skin blood flow was measured with a laser Doppler blood flowmeter and a sheet of polyurethane (decompression medium) in the sacral region. Data were also obtained from patients with and without decubitus ulcers, and whose levels of albumin, total cholesterol, and triglyceride for three months were known. When the decompression medium was used, skin blood flow changed significantly after body position was changed in the patients who used paper diapers. Nutritional analyses showed significant differences in the levels of albumin and total cholesterol between patients with and without decubitus ulcers. The levels of albumin and total cholesterol were lower in the patients with decubitus ulcers than in those without decubitus ulcers. Because the cloth diapers acted as a compression factor, even an externally applied decompression medium did not suppress the reductions in skin blood flow.

Aged↗
PubMed1991

[Factors predicting development of decubitus ulcers among patients admitted for neurological problems].

In this prospective study, factors contributing to the development of decubitus ulcers were examined. Factors were identified by a literature review and a conceptual framework was developed. Regular observations were made during the subjects' hospitalization to determine the incidence of decubitus ulcers, and to assess other decubitus ulcer risk factors. Seventeen out of 146 admitted for neurological problems patients developed decubitus ulcers during the three month study period. There were no significant differences in the level of serum albumin, hemoglobin or age between those who developed decubitus ulcers and those who did not. There also was no difference in incidence between patient who were paralyzed and those not paralyzed. Mean hospitalization days until decubitus ulcer development was 6.5 days. According to the results of discriminant analysis, four factors--1) friction and shear, 2) sensory perceptual impairment, 3) low diastolic pressure, and 4) multiple use of sedative medications--predicted 84.93% of decubitus ulcer incidence.

Humans↗
PubMed1981

The use of the right decubitus position in computed tomography of the liver and pancreas.

Sixty patients underwent computed tomography (CT) with a 20 s scanner of the upper abdomen in the supine and right decubitus positions. The images of the liver were compared. The scores for the hepatic image were better when the patient was in the right decubitus position. The scores for the image of the pancreatic head were about the same in the two positions but improvement occurred in the right decubitus position in nearly half the patients. Scores for the other parts of the pancreas and for the pancreas as a whole were usually worse when in the right decubitus position although improvement did sometimes occur. Scanning in the right decubitus position has been demonstrated to be of value in reducing artefact shadows in the hepatic image and may on occasions improve the quality of the pancreatic image. Accordingly scanning in the right decubitus position is a useful aid when supine views have given poor results or when the presence of a lesion is equivocal.

Humans↗
PubMedDate not supplied

Cautious use of administrative data for decubitus ulcer outcome reporting.

The purpose of this study is to demonstrate that caution should be exercised when using administrative data, exclusively, to report quality and safety outcomes. Investigators identified hospital-acquired decubitus ulcers using Agency for Health-care Research and Quality (AHRQ) patient safety indicator definitions. As validation of this method, investigators abstracted 123 medical charts of patients identified through AHRQ methodology as having hospital-acquired decubitus ulcers. Abstraction of these cases produced a change in rate from 23.3 decubitus ulcers per 1000 patients, derived through administrative data, to a true rate of 7.9 decubitus ulcers per 1000 patients, a 66% reduction. Investigators found 2 additional flaws (1 internal and 1 methodological) that further decreased the decubitus ulcer rate to 6.14 per 1000, a 74% variance. The results of this study suggest that administrative data, when used alone, are not sufficient in measuring the true rate of hospital-acquired decubitus ulcers.

Cross Infection↗
PubMedDate not supplied

[Care plan for patients in prone decubitus. An experience from practice].

Offering a specific integral attention to patients with SDRA in prone decubitus positions makes us establish a performance plan with the aim to know the problems derived from the change in position, the time staying in prone decubitus and to standardize a care plan. We review the clinic records of the patients admitted in our unit from March '93 to March '95 who were positioned in prone decubitus. Taking as a base the nursing care model of V. Henderson and the taxonomy of NANDA, we analyse the needs which have been altered, and determine the nursing diagnosis, complications and most frequent interdependent problems establishing the aim to accomplish, planning the performance and rationalization. Five patients were positioned in prone decubitus before planning the performance and four more afterwards. All the patients tolerated SNG diet keeping a correct bowel transit. One patient showed an ulcera at frontal level. There were neither comeal ulceras nor alterations in the oral mucossa. The vascular accesses remained permeable. DP caused facial and periorbital edema in all the patients. We did not observe any increase in the amount of bronchial secretions. The eight patients who tolerated the change in position stayed in prone decubitus for an average of 77 hours, with a range of 10 to 216 hours. Four patients were discharged from the hospital, two of whom showed movility alterations, independently of the time staying in prone decubitus. We state explicitly the nursing care, determine five nursing diagnosis, one problem and seven interdependent complications. Establishing the nursing care from the experience and review of the records has allowed us to be more specific and objective. Standardizing the specific care plans makes the nursing care easier when dealing with real problems as well as with the care of complications derived from this situation.

Clinical Protocols↗
PubMed2002

Lateral decubitus HRCT: a simple technique to replace expiratory CT in children with air trapping.

OBJECTIVE: To evaluate the effectiveness of lateral decubitus high-resolution CT (HRCT) in detecting air trapping in children. MATERIALS AND METHODS: HRCT scans of 21 children with heterogeneous lung attenuation caused by air trapping (n = 10) or with infiltrative lung disease (n = 11) were reviewed retrospectively. The air-trapping disease included bronchiolitis obliterans (n = 7), bronchial obstruction due to mediastinal lymphoma (n = 1), endobronchial haemangioma (n = 1) and foreign body aspiration (n = 1). HRCT was performed in both lateral decubitus positions as well as the supine position. The attenuation (Hounsfield units; HU) was measured in both the hypo- and adjacent hyper-attenuating areas of the heterogeneous lung portion, and the difference of attenuation between these two areas was calculated in the supine and both lateral decubitus scans, respectively. The attenuation differences of the three scans were compared in each group. RESULTS: The attenuation difference was larger in the ipsilateral decubitus (207.95 +/- 105.24 HU) scans than in the contralateral (121.25 +/- 90.05 HU) or supine (162 +/- 94.01 HU) scans in the air-trapping group (P < 0.05). There were no significant differences among the three scans in the infiltrative lung disease group (P > 0.05). CONCLUSIONS: Lateral decubitus HRCT is an effective adjunct to standard HRCT in the evaluation of air trapping as a cause of mosaic lung attenuation in uncooperative paediatric patients.

Airway Obstruction↗
PubMed2003

Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial.

Low-level laser therapy (LLLT) has been suggested as a promising treatment option for open wounds. In view of the absence of randomised studies with sufficiently large sample sizes, we assessed the efficacy of LLLT in the treatment of stage III decubitus ulcers. We performed a prospective, observer-blinded multicentre randomised clinical trial to assess the effect of LLLT as adjuvant to standard decubitus care. A total of 86 patients were enrolled into the study. Treatment was the prevailing consensus decubitus treatment (n=47); one group (n=39) had LLLT in addition, five times a week over a period of 6 weeks. The primary outcome measure was the absolute (mm2) and relative (%) wound size reduction at 6 weeks compared to baseline. Secondary outcome measures were the number of patients developing a stage IV ulcer during the study period, and the median change in Norton scores at 6 weeks compared to baseline. Based on the intention-to-treat principle, using last-observation-carried-forward analyses, Mann-Whitney U tests showed that the differences between the two groups in terms of absolute improvement (p=0.23) and relative improvement (p=0.42) were not significant. Because the wound size areas were non-normally distributed, we also analysed the data after logarithmic transformation of the wound size measurements. No significant difference in log(e) improvement scores between groups could be demonstrated (unpaired t-test: p=0.59). During the treatment period 11% of the patients in the control group and 8% of the patients in the LLLT group developed a stage IV decubitus ulcer (Fisher's exact test: p=0.72). The patients' Norton scores did not change during the treatment period. In this trial we found no evidence that justifies using low-level laser therapy as an adjuvant to the consensus decubitus ulcer treatment.

Aged↗
PubMed2006

Which is a better position for insertion of a high thoracic epidural catheter: sitting or lateral decubitus?

OBJECTIVE: The purpose of this study was to compare the safety and success rates associated with the placement of a high thoracic epidural catheter in the sitting vs. the lateral decubitus position. DESIGN: Prospective randomized study. SETTING: University hospital. PARTICIPANTS: Forty-one patients scheduled for off-pump coronary artery bypass graft surgery (OPCAB) by means of high thoracic epidural anesthesia at Th 1/2. INTERVENTIONS: The epidural catheter was placed into the patients in the sitting or lateral decubitus position. The success rates, the time for catheter insertion, the incidence of adverse events, and the accuracy of the catheterization in both groups were compared. MEASUREMENTS AND MAIN RESULTS: The success rates in both groups were comparable, whereas 20% of patients showed a vagal reflex during epidural catheterization in the sitting group (p < 0.05). The insertion time in the sitting group was significantly shorter than in the lateral decubitus group (p < 0.05). Accuracy at the first attempt to the Th1/2 epidural space was 93% in the sitting group and 73% in the lateral decubitus group, but there was no statistically significant difference (p = 0.186). CONCLUSIONS: It is recommended to use the lateral decubitus position for high thoracic epidural catheterization in patients scheduled for OPCAB to avoid vagal reflexes.

Aged↗
PubMed1992

The relationship between extended periods of immobility and decubitus ulcer formation in the acutely spinal cord-injured individual.

Several variables may influence the development of decubitus ulcers during the acute treatment phase following spinal cord injury. Three independent variables were studied: level of injury, completeness of injury and length of time immobilized. Of these, length of immobilization exceeding 6 hours was associated with subsequent development of a sacral or occipital decubitus at a statistically significant level (p = .0094). The presence of a complete injury was associated with decubitus formation at a noticeable but statistically insignificant level (p = .0759). Cervical injuries were not associated with an increased rate of decubitus formation. Results suggested that initial treatment of acute spinal cord injuries should include the use of pressure relieving maneuvers or devices as soon as possible, especially in patients with anticipated extensive immobilization. Recognizing that risk of decubitus formation increases with immobilization time, the period of time involved in initial diagnosis and intervention should be kept to a minimum. This is particularly true in patients with complete spinal cord injuries.

Adolescent↗
PubMed1997

The effect of the lateral decubitus position on vagal tone.

The average person spends about one-third of their time in a recumbent position. However, little is known about the effect of recumbent posture on autonomic nervous activity. Manoeuvres which can increase vagal tone have been sought both in the normal subject and in patients with heart disease. We have studied the autonomic effect of various recumbent positions, namely the supine, left lateral decubitus and right lateral decubitus positions, in healthy subjects by using spectral heart rate variability analysis. Both time- and frequency-domain measures were calculated and compared between the three recumbent positions. The normalised high-frequency power was used as the index of cardiac vagal activity, the normalised low-frequency power as the index of cardiac sympathetic activity and the low-frequency power/high-frequency power ratio as the index of sympathovagal balance. The normalised high-frequency power is highest in the right lateral decubitus position, followed in decreasing order by left lateral decubitus and supine positions. The low-frequency power/high-frequency power ratio has the reversed trend as compared with that of the normalised high-frequency power. These results suggest that cardiac vagal activity is greatest when the right lateral decubitus position is adopted.

Adult↗
PubMed2005

Decubitus ulcers: a review of the literature.

Decubitus ulcers are a worldwide health care concern affecting tens of thousands of patients and costing over a billion dollars a year. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture), and internal factors (e.g. fever, malnutrition, anaemia, and endothelial dysfunction). Often, enough damage is done to create the basis for a decubitus ulcer after as little as 2 h of immobility, a situation which may be difficult to avoid if the patient must undergo prolonged surgery or remain bedridden. Damage owing to pressure may also occur hours before the patient receives medical attention, especially if the patient falls or becomes immobilized owing to a vascular event. Several classification systems for decubitus ulcers have been described, based on where injury first occurs. The histologic progression of decubitus ulcers is a dynamic process involving several stages, each having characteristic histologic features. A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates. With accurate risk assessment and preventative care, we can hope to minimize complications and mortality owing to decubitus ulcers.

Humans↗
PubMed2005

Historical perspective on pressure ulcers: the decubitus ominosus of Jean-Martin Charcot.

Jean-Martin Charcot was a towering figure in the French medical community in the 19th century. Among the diseases he studied was the decubitus, or pressure ulcer, as it is commonly called today. He did not believe that pressure or local irritation were causative factors for the decubitus but rather subscribed to the "neurotrophic theory," which held that damage to the central nervous system led directly to its occurrence. Charcot observed that many patients who developed eschar of the sacrum and buttocks died soon afterwards, and referred to this lesion as the decubitus ominosus, implying that its occurrence heralded impending death. His description of the evolving decubitus is extraordinarily detailed and accurate and includes complications that are seldom seen today, such as gangrenous metastases to the lung and invasion of the spinal cord. Charcot's therapeutic nihilism is largely a product of the limited medical technology of his day. The importance of risk factor assessment and timely intervention for persons at risk is now understood. In addition, it is recognized that not all pressure ulcers are unavoidable and that many ulcers, particularly those in early stages, can be reversed. Comparing Charcot's view of the decubitus with our own, insight is provided into the way medicine is practiced today.

France↗
PubMed1989

Detection of pneumonia by auscultation of the lungs in the lateral decubitus positions.

Forty-five acutely ill, coughing patients, three with acute dyspnea and cardiomegaly, and 37 control subjects were placed in lateral decubitus positions for auscultation of their dependent lungs to determine if this maneuver would elicit inspiratory crackles, signs of pneumonia. In the upright position, auscultation of the lungs was normal in all control subjects and in lateral decubitus positions their dependent lungs revealed transient late inspiratory crackles in seven of the 37 (18.9%), and transient inspiratory peeling sounds in two others (5.4%). Thirteen acutely ill, coughing patients, free of prior cardiac and pulmonary diseases, had persistent late inspiratory crackles induced in one or both dependent lungs when placed in lateral decubitus positions. These dependent lungs also revealed increased numbers of crackles in three patients, late inspiratory squeaks in four, and wheezes in three others. In the upright position, auscultation of the lungs was normal in 10 of these patients, and a few basilar crackles were heard in three others. All of these abnormal findings cleared after treatment with antibiotics. Thirty-one of 32 acutely ill, coughing patients with bronchitis, sinusitis, or pharyngitis were free of induced crackles in dependent lungs in lateral decubitus positions. However, placement of two other patients in these positions appeared to have elicited the inspiratory crackles of chronic pulmonary disease and early congestive heart failure. These observations suggest that placement of acutely ill, coughing patients into lateral decubitus positions for auscultation of the dependent lungs may be a valuable maneuver for diagnosis of pneumonia.

Adult↗
PubMedDate not supplied

Venous air embolism: comparative merits of external cardiac massage, intracardiac aspiration, and left lateral decubitus position.

The treatment of venous air embolism was compared in adult mongrel dogs utilizing left lateral decubitus position, external cardiac massage, and intracardiac aspiration of air. Following the rapid injection of a lethal dose (15 ml/kg) of air, it was found that the left lateral decubitus position and external cardiac massage each produced 57.1 percent survival, both being as effective as intracardiac aspiration of air (61.9 percent survival). Resuscitation time was shortest in dogs treated with intracardiac aspiration, 2.7 +/- 0.28 minutes, whereas with external cardiac massage and left lateral decubitus position, resuscitation times were 18.3 +/- 2.1 minutes and 19.50 +/- 3.0 minutes, respectively. Our study shows external cardiac massage, left lateral decubitus position, and intracardiac aspiration to be equally effective in the treatment of venous air embolism. Our data did not show intracardiac aspiration to be superior to either external cardiac massage of left lateral decubitus position despite the shorter resuscitation time. External cardiac massage has the advantage of simplicity and speed of initiation.

Animals↗
PubMed2000

[Effect of left ventricular diastolic dysfunction on pathogenesis of angina decubitus].

OBJECTIVE: To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus. METHODS: The study population consisted of three groups: (1) group 1, 31 patients with angina decubitus who had ejection fraction > 50%; (2) group 2, 20 patients with coronary artery disease but without angina decubitus; group 2 and 1 were matched for age, EF and extent of coronary artery disease; (3) group 3, 20 patients without cardiovascular diseases. RESULTS: Left ventriculography (LVG) showed that LV first 1/3 filling fraction (1/3 FF) and LV late 1/3 FF were 0.30 +/- 0.12, 0.41 +/- 0.12, 0.46 +/- 0.07 and 0.36 +/- 0.09, 0.31 +/- 0.08, 0.29 +/- 0.06 in groups 1 to 3 respectively. LV first 1/3 FF was significantly lower in group 1 than in group 2 and 3 (both P < 0.001), but LV late 1/3 FF was much higher in group 1 than in groups 2 and 3 (P < 0.05 and P < 0.01, respectively). Left ventricular end-diastolic pressure (LVEDP) was markedly increased before and after LVG in groups 1 and 2 as compared with group 3 (P < 0.001 and P < 0.05, respectively). The difference of LVEDP caused by left atrial contraction (LACD) was much higher before and after LVG in group 1 than in group 3 (P < 0.01 and P < 0.001, respectively). However, there were significant differences in LVEDP and LACD tested between before and after LVG in group 1 (both P < 0.01). No statistical differences were found in LVEDP and LACD tested between before and after LVG in both group 2 and group 3. CONCLUSION: Patients with angina decubitus have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.

Adult↗