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PubMed1992

[Norton's decubitus risk score in a nursing home].

Decubitus must be considered an important problem in public health care. In the Netherlands (total population 15 million) the costs of prevention and treatment of decubitus in the hospitals and nursing homes are approximately Dfl. 700 million per year. In order to identify patients at risk for the development of decubitus at an early stage. Norton and colleagues developed a scoring system that includes an assessment of general physical condition, mental status, activity level, mobility and incontinence. In a prospective study in 224 somatic nursing home patients we investigated the relationship between the Norton-score and the appearance of decubitus. The authors conclude that, when using the Norton-score, it is not possible to differentiate patients at risk clearly from patients with no risk. From the five items used by Norton, only mobility and, to a lesser degree, general physical condition, show a significant relation with the occurrence of decubitus ulcers. In order to identify the patients at risk roughly, the physician can suffice with scoring these two items.

Activities of Daily Living↗
PubMed2006

[Combined treatment of refractory decubitus ulcers].

OBJECTIVE: To summarize the clinical experience in the treatment of refractory decubitus ulcers. METHODS: From May 1998 to March 2005, 22 patients with decubitus ulcers (29 decubitus ulcers) were admitted, whose age was 36-92 years. The lesion size was 4 cm x 2 cm to 18 cm x 15 cm. The locations of decubitus ulcers were the sacrococcygeal region (18 cases), the tuber ischiadicus region (6 cases) and the trochanter major region (5 cases). Enteral nutrient was given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient's age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm x 4 cm-12 cm x 10 cm; 10 by fasciocutaneous flaps, 10 cm x 7 cm-20 cm x 17 cm; 9 by gluteus maximus myocutaneous flaps, 13 cm x 11 cm-17 cm x 14 cm; and 6 by long-head of biceps femoris flaps, 11 cm x 6 cm-14 cm x 7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days. RESULTS: General nutritional status was improved, hemoglobin was greater than 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a follow-up of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory. CONCLUSION: Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation.

Adult↗
PubMed1996

Left ventricular diastolic dysfunction in patients with angina decubitus.

OBJECTIVE: To investigate the relationship between left ventricular diastolic dysfunction and episodes of angina decubitus. METHODS: The study population consisted of three groups, groups I (20 controls) had no cardiovascular diseases. Group II (20 patients) had coronary artery disease (CAD) without angina decubitus. Group III (24 cases with ejection fraction (EF) > 45%) were selected from 26 patients with angina decubitus. RESULTS: Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction (1/3FF) was significantly reduced in groups III as compared with groups II and I (P < 0.01). Left ventricular end-diastolic pressure (LVEDP) significantly increased in patients with angina decubitus after LVG as compared with that before LVG (P < 0.01). However, there were no statistically differences in LVEDP, before and after LVG in both groups II and I. CONCLUSIONS: Patients with angina decubitus have abnormalities of LV diastolic filling and decrease in LV compliance.

Adult↗
PubMedDate not supplied

[Incidence of decubitus ulcers in an intensive care unit].

Decubitus ulcers are an important problem which must be known by health professionals in general and by nurses in particular. Its prevention is one of the basic care in Nursing. This care becomes especially relevant in patients who are admitted into Intensive Care Units. The objectives of the study are to know the incidence rate of patients who develop decubitus ulcers during their stay in the Unit and the proposal to introduce measures aiming to decrease its incidence. In general, the study proves that 17% of patients develop decubitus ulcers during their hospitalization and that 31.8% of patients who are catalogued as risk patients develop ulcers. The preventive measures introduced are the reassessment and application of prevention and treatment of decubitus ulcers protocols, the creation of improvement groups where these problems are approached, perfecting courses about decubitus ulcers, clinical sessions where strategies are unified, graphic divulging measures (notices, etc.) and antiscaric materials such as heelers, small cushions for head support, pillows, etc.

Female↗
PubMed2003

Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions.

PURPOSE: The aim of this prospective study was to assess the value of chest sonography in the radiologic diagnosis of small pleural effusions (relative to expiratory lateral decubitus radiography) and to suggest gray-scale sonographic criteria for detecting the presence of small pleural effusions. METHODS: Patients referred for abdominal or chest sonographic evaluation for various reasons were also examined for sonographic features of pleural effusion from May 1, 1997, until January 31, 2000. Patients who had evidence of small pleural effusions were included. Patients with no such evidence served as a control group. Subsequently, all patients underwent erect posteroanterior and expiratory lateral decubitus chest radiography. RESULTS: On chest sonography, 52 patients were found to have small pleural effusions. The control group consisted of 17 patients. The mean thickness of the pleural effusion was 9.2 mm on sonography and 7.6 mm on expiratory lateral decubitus radiography (p < 0.01). Compared with radiologic examination, chest sonography had a positive predictive value of 92% in the diagnosis of small pleural effusions in our study population. CONCLUSIONS: Chest sonography showed a high degree of accuracy relative to that of lateral decubitus chest radiography in the diagnosis of small pleural effusions, which appeared as thin (usually 15 mm thick or less) anechoic areas that changed shape with the phases of respiration.

Adult↗
PubMed1993

Aortocaval compression in the sitting and lateral decubitus positions during extradural catheter placement in the parturient.

We prospectively studied the incidence of concealed aortocaval compression in parturients at term during identification of the extradural space. Forty ASA I or II parturients, at term and in active labour, who requested extradural analgesia were randomly allocated to one of two groups. Parturients in the first group (n = 22) were positioned in the left lateral decubitus position and those in the second group (n = 18) were in the sitting position. Cardiac output (CO) was recorded at one-minute intervals for five minutes before extradural catheter placement (supine position with a 15 degrees wedge under the right side), and during and thereafter for five minutes (in the supine wedged position), using the BoMED NCCOM3-R7 thoracic electrical bioimpedance (TEB) monitor. The average of five COTEB recordings before positioning the patient were compared with the average of five COTEB measurements during and after extradural space identification. A change of > 25% COTEB was considered beyond machine variability. Upper limb arterial pressure was recorded at one-minute intervals. In the left lateral decubitus position, 17 of 22 patients demonstrated a > 25% reduction in COTEB compared with five of 18 patients in the sitting position (chi 2, P < 0.01). The percentage change in COTEB in the lateral decubitus position (-29.8%, 95% CI -17% to -44%) was greater than the sitting position (-9.8%, 95% CI +36% to -32%) (P < 0.01). A decreased incidence of aortocaval compression during identification of the extradural space was demonstrated in the sitting position when compared with the left lateral decubitus position.

Adult↗
PubMed1994

Duration of decubitus position after epidural blood patch.

Thirty patients presenting with post-dural puncture headache (PDPH) were prospectively studied to determine the influence of the duration of the decubitus position after epidural blood patch on the efficacy of treatment. All patients received 12 ml of autologous blood. They were randomly distributed into three groups of ten patients. Patients in Group 1 were maintained in a decubitus position for 30 min after the epidural injection of autologous blood in the epidural space. Patients in Group 2 were maintained for 60 min in decubitus and patients in Group 3 for 120 min. Post-dural puncture headache was evaluated using a visual analogue scale before the epidural blood patch, at the time of initially adopting a standing position after the blood patch, and 24 hr later. The severity of PDPH in the three groups was reduced at the time of initially adopting a standing position and after 24 hr, in comparison with preblood patch VAS (P < 0.001). Patients in Group 3 presented less severe PDPH than patients in Group 1 at the time of initially standing up and 24 hr later (P < 0.05). We conclude that epidural blood patch was effective in treating PDPH but that the maintenance of a decubitus position for at least one hour and preferably for two hours after the blood patch was more effective than maintenance for 30 min.

Adult↗
PubMed1986

The contralateral decubitus chest film.

The radiology and emergency medicine literature have emphasized the value of the cross-table decubitus chest film taken with the hemithorax containing the suspected pathology in the dependent position. When used in conjunction with the upright chest film, the contralateral decubitus film (with the side of interest up) often reveals more information than does the film with the side of interest dependent. The unsuspected bilaterality of pleural effusion, especially when subpulmonic, often is revealed, as is pathology in the lung base that is obscured by large effusion or cardiomegaly. Masses, cavities, and areas of consolidation may become apparent. Especially important in pediatric patients, vascular structures can be distinguished from infiltrate. The contralateral decubitus film should be obtained when examinations in other positions have yielded equivocal results, rather than repeating an examination. This avoids unnecessary radiation exposure and is cost effective. Because of their complementary nature, in many cases both decubitus views should be obtained.

Humans↗
PubMed2002

Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population.

OBJECTIVE: We investigated the prevalence and associated risk factors of decubitus ulcer in an institutionalized Spanish elderly population. METHODS: A 1 d cross-sectional study in 50 Spanish geriatric facilities was carried out. Data collection included age, sex, body mass index, presence of decubitus ulcer, duration of ulcer, days of hospitalization, risk according to the Norton scale, associated risk factors, and nutrition status evaluation including assessment according to the Nutrition Screening Initiative. Logistic regression analysis calculated prevalence and association with risk factors. RESULTS: Data from 827 elderly people (71.3% female) were collected. Mean age (+/- standard deviation) was 82.4 (+/-8.0) y. Decubitus ulcer prevalence was 35.7%, with no sex differences (34.1% males and 37.2% females). Body mass index was inversely associated with ulcer prevalence in a statistically significant way (odds ratio = 0.94, 95% confidence interval = 0.92-0.97), but the following were risk factors: age (1.03, 1.01-1.06), previous ulcer (3.09, 2.16-4.04), diabetes (1.54, 1.02-2.51), functionality (2.91, 2.05-4.12), immobility (8.30, 5.09-11.51), erythema (12.12, 7.46-16.78), dehydration (2.09, 1.31-2.87), and edema (2.35, 1.64-3.06). Subjective evaluation of nutrition status and nutrition status as assessed by the Nutrition Screening Initiative Determine scale (modified) showed a significant linear association with ulcer (P < 0.001), and a score above 14 points in the modified Norton scale was associated with a lower ulcer rate (P < 0.001). CONCLUSIONS: Prevalence of decubitus ulcer in the Spanish elderly population increased with age, poor nutrition status, immobilization, and impaired functionality.

Age Factors↗
PubMed1996

Magnetic resonance imaging examinations of gluteal decubitus ulcers in spinal cord injury patients.

The purpose of our study was to use magnetic resonance imaging (MRI) to determine deep changes in soft tissues and bones underlying decubitus ulcers which occur in spinal cord injury (SCI) patients. By diagnosing these deep changes adjacent to decubitus ulcers, MRI can facilitate proper clinical management and prevent contraindicated surgery. MRI evaluation was performed on 37 male SCI patients for a total of 44 diagnostic studies. The studies were evaluated by the following criteria: 1) the presence of an adjacent fluid collection, 2) bone involvement raising the possibility of osteomyelitis and 3) heterotopic bone formation. Results demonstrated 11 patients (29.7 percent) with fluid collection in the deep soft tissues underlying the decubitus ulcer and eight patients (21.6 percent) with abnormal adjacent bone marrow signal. Four patients (10.8 percent) had heterotopic bone formation near the ulcer. We conclude that MRI is helpful in determining the depth and extent of soft tissue involvement underlying decubitus ulcers including underlying fluid collections, heterotopic bone formation and evidence of adjacent bone marrow edema. This is beneficial in planning proper therapy.

Adult↗
PubMed1985

New design of an anti-decubitus lying-down support.

Reviewed is a new lying-down support which is developed and designed in order to prevent decubitus. The new design is based upon the new anti-decubitus theory about tissue deformation: the principle of minimal deformation of the supported body-tissues. Reviewed are the main problems of decubitus prevention in the lying situation. A comprehensive explanation of the operation of the new lying-down support is given. Attention is paid to the anti-decubitus quality, the users-friendliness for medical attendants, nursing attendants and the patient himself, the maintenance-friendliness and the cost-price. User-aspects, safety-aspects and the cost-factor are discussed in detail.

Air↗
PubMed2004

Necrotizing soft tissue infection from decubitus ulcer after spinal cord injury.

STUDY DESIGN: A case of necrotizing soft tissue infection in a patient with spinal cord injury with extension of infection into the spinal canal and spinal cord is presented. OBJECTIVE: To review the history, risk factors, pathophysiology, diagnosis, treatment, and morbidity and mortality regarding necrotizing soft tissue infection as they relate to spinal cord injury. SUMMARY OF BACKGROUND DATA: Necrotizing soft tissue infection related to decubitus ulcers is rare. To our knowledge, this is the first report of this disease related to a sacral decubitus ulcer with extension of the necrotizing infection into the spinal canal. METHODS: The clinical, radiographic, and pathologic features associated with necrotizing soft tissue infection are presented. The patient presented with a late-stage necrotizing soft tissue infection requiring extensive de-bridement of necrotic tissue, which the patient underwent on admission. RESULTS: The patent died of refractory septic shock and multiple-organ failure after surgery. CONCLUSION: Necrotizing soft tissue infections from decubitus ulcers are rare and unpredictable, and ultimately have a progressively aggressive course. The case reported herein is the first report of necrotizing soft tissue infection from a decubitus ulcer in a patient with spinal cord injury with extension into the spinal canal and spinal cord.

Abdomen↗
PubMed2001

Seizures, lateral decubitus, aspiration, and shoulder dislocation: Time to change the guidelines?

The recommendation to position a patient having a seizure on a lateral decubitus is aimed at minimizing the risk of aspiration. The authors reviewed the database of the Epilepsy Foundation Clinic of South Florida for patients with epilepsy treated for pneumonia between May 1999 and May 2000 and patients admitted to two university telemetry units who had dislocation of the shoulder during an epileptic seizure. Over 2 months, 2 of 733 adults with intractable seizures had aspiration pneumonia after a generalized tonic clonic seizure (GTCS). Although no study has specifically addressed the problem of aspiration pneumonia in adults with GTCS, our findings suggest this problem is not common. From the two epilepsy centers, 5 of 806 patients dislocated a shoulder during a seizure. Video recordings showed that these patients were positioned in a lateral decubitus by staff while still having the convulsion. The dislocated shoulder in all cases was on the lower side. The risk of shoulder dislocation in a convulsing patient positioned in a lateral decubitus is less than 1%. Nevertheless, dislocations can result in disabling recurrences and are easily preventable. Because aspiration is more likely in the postictal rather than ictal phase of a GTCS, when oral secretions are not usually increased and there is cessation of respiratory movements, lateral decubitus should only be implemented after cessation of the convulsion, In inpatients (such as those on telemetry), secretions may be better managed by bedside aspiration of the oral cavity.

Epilepsy↗
PubMed2002

[The influence of complications on rehabilitation of spinal cord injuries: economical minus effects and physical disadvantages caused by urinary tract infection and decubitus ulcer].

There are few studies on the many complications that disrupt the rehabilitation of patients with cervical cord injuries and their subsequent health-economic benefits. I particularly focused on the treatment of urinary tract infection and decubitus ulcers because these are very frequently encountered complications in a clinical setting. I examined how these complications affect the progress of rehabilitation and facilitate a patient's return to society. The subjects included ninety-eight cervical cord injury patients with tetraplegia who were discharged from the Rehabilitation Center for Severely Disabled Persons from 1995 to 2000. I retrospectively investigated these ninety-eight subjects regarding ninety-six items from clinical records, among which twenty items were selected because they are considered to be closely associated with outcome, such as age, sex, length of stay, medical expense, urinary tract infection, and decubitus ulcer. Moreover, I examined the influence that urinary tract infection and decubitus ulcer had on other items. The average length of stay and total medical expenses per patient were 1,174.4 +/- 559.9 days and 13,563,128.4 +/- 6,351,078.1 yen, respectively. Urinary tract infection and decubitus ulcer occurred at a rate of 97% in patients with cervical cord injury undergoing chronic stage rehabilitation, and these complications caused a two-fold prolongation of the length of stay and a three-fold increase in medical expenses compared with patients without complications. It is important to fully recognize that these complications produce many expenses as well as those for the medical treatment of cervical cord injury.

Adolescent↗
PubMed2005

Lateral decubitus position generates discomfort and worsens lung function in chronic heart failure.

BACKGROUND: Lateral decubitus position is poorly tolerated by heart failure patients. STUDY OBJECTIVES: To evaluated pulmonary function and lung diffusion in heart failure patients in the following five body positions: sitting, prone, supine, and left and right decubitus. SETTING: Heart failure unit of a university hospital. SUBJECTS: We studied 14 chronic heart failure patients in New York Heart Association class III and 14 healthy volunteers. MEASUREMENTS AND RESULTS: After 15 min of a selected position, subjects were evaluated by a discomfort scale, ear oximetry, and pulmonary function, which included FEV1, FVC, vital capacity (VC), alveolar volume, and diffusing capacity of the lung for carbon monoxide (D(LCO)) with subcomponent membrane resistance (DM) and capillary volume. In healthy subjects, we observed a reduction of D(LCO) and capillary volume in both lateral decubiti. Some discomfort was documented in both lateral decubiti when selected positions were compared with the sitting position. In the sitting position, pulmonary function suggested slight restriction ([mean +/- SD] FVC, 89.8 +/- 22.3% predicted; FEV1, 84.7 +/- 16.9% predicted, VC, 88.6 +/- 21.5% predicted; and FEV1/VC, 74 +/- 7) with low D(LCO) (73 +/- 19% predicted). Compared with sitting, lung mechanics were unchanged in prone and supine positions; FEV1, FVC, and FEV1/VC were lower when patients were lying on their side, with unchanged alveolar volume and VC. D(LCO) was similar when comparing sitting, prone, and supine positions, and it was lower in lateral decubitus because of the lower capillary volume (vs sitting) and DM (vs prone and supine). Body position-related FVC and D(LCO) reduction were greatest in the largest hearts (deltaFVC and deltaD(LCO) vs left ventricle diastolic volume R = 0.524, p < 0.05 and R = 0.630, p < 0.02, respectively; deltaFVC and deltaD(LCO) vs cardiothoracic index R = 0.539, p < 0.05 and R = 0.685, p < 0.01, respectively). CONCLUSIONS: In heart failure, lateral decubitus airway obstruction and lung diffusion impairment become greater as heart dimensions increase.

Aged↗
PubMed1977

The lateral decubitus view: an aid in evaluating poorly defined pulmonary densities in children.

The upper lung on a lateral decubitus chest radiograph is uniformly better expanded than on a frontal upright chest radiograph. The lateral decubitus view is useful in distinguishing pulmonary vascular structures mimicking pneumonia from actual pulmonary infiltrates in infants and young children in whom deep inspiratory chest films are difficult to obtain. This study included 20 children whose initial radiographs could not be obtained in deep inspiration and demonstrated equivocal areas of pulmonary infiltrate. Clinical follow-up was possible in 16 of the 20 patients. We reviewed the routine chest radiographs and lateral decubitus views independently and retrospectively. The decubitus films showed more appropriate correlation with the subsequent clinical course and consistently allowed more confident interpretation of the radiographs.

Diagnosis, Differential↗
PubMed2003

[Use of risk scales for decubitus ulcers as screening instruments--A systematic review of external evidence].

CONTEXT: Reports on the preventive effects of scales to measure the risk of decubitus ulcer development of patients in various care settings have been inconsistent. The value of the different tools as screening instruments for risk factors as one step of a screening program has not yet been evaluated. OBJECTIVE: To evaluate the prognostic validity of scales measuring the risk of decubitus ulcer development. DATA SOURCES: Studies published in English or German and reporting trials of validity and reliability of scales measuring the risk of decubitus ulcer of patients in any care setting were identified through searches of Medline and CINAHL, Carelit and Heklinet (1981-2000). Reference lists of earlier reviews were checked. STUDY SELECTION: 257 abstracts were screened; 43 publications were assessed initially, 24 publications were analysed after exclusion criteria have been applied. DATA EXTRACTION: Abstracts were screened and data on study objective, scale, cut-off, follow-up, population, setting, sensitivity and specificity, trial quality including blinding, reference standard and outcome measurement were assessed. DATA SYNTHESIS: 24 studies analysed five instruments. Due to heterogeneity in study design, methodological quality and outcome assessment pooling of data was not feasible. Only data on the Braden Scale allowed the calculation of likelihood ratios for each point of the scale. Likelihood ratios for the Braden Scale were moderate [LR+ 0.3-7.7 (Cut-off 16)], and fair for the Norton Scale [LR+ 1.4-2.8 (Cut-off 14)]. CONCLUSION: The tools investigated as instruments of primary prevention of decubitus ulcers show that their test performance is inadequate. Thus, they are unlikely to be effective as screening instruments for any institutionalised patient group and care setting.

Humans↗
PubMed1978

Sinography in management of decubitus ulcers.

Draining sinuses are considered a major complication of decubitus ulcers in spinal cord injury patients. Of 144 such patients with decubitus ulcers admitted in 1975 and 1976, 15 had draining sinuses. Twenty-one sinograms were obtained in the process of their evaluation prior to treatment. In 6 patients, sinography resulted in unexpected findings such as excessive depth of the sinus tract, abscess formation, undermining of previous graft, and extension into neighboring joints, affecting both the management of the decubitus ulcers and the surgical approach. It is concluded that sinography should become an integral part of management of decubitus ulcers with draining sinuses.

Abscess↗