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PubMed1994

Prospective study of decubitus ulcers in two long term care facilities.

The incidence and prevalence of decubitus ulcers, and their complications and microbiology were studied prospectively in two large long term care facilities in Winnipeg, Manitoba between January 1, 1989 and December 30, 1990. The initial prevalence of decubitus ulcers was 2.6 and 1.6% at the two institutions, with an incidence of 3.4 and 4.8 per 100,000 resident days, respectively. The incidence of decubitus ulcer infection was 1.4 per 1000 ulcer days. The only other complication identified was in one resident who required an indwelling catheter to permit ulcer healing. An average of 2.4 organisms grew from surface swabs of ulcers; anaerobes were isolated from 14% of cultures. Aspirates from clinically noninfected ulcers had bacteria isolated in 30% of specimens. Two-thirds of organisms isolated were considered potentially pathogenic. Concurrent bacteriuria was present for 75% of sampling episodes. Organisms present in the urine were simultaneously isolated from decubiti in only 5% of specimens. Decubitus ulcers are uncommon in long term care institutions. The urinary tract of the bacteriuric elderly appears to be an infrequent source of organisms colonizing decubiti.

Adult↗
PubMed1998

The advantages of the lateral decubitus position after spinal anesthesia with hyperbaric tetracaine.

UNLABELLED: We investigated the effects of lateral decubitus positioning after spinal anesthesia with hyperbaric tetracaine on the spread of sensory blockade and hemodynamic variables. One hundred ASA physical status I or II patients scheduled for elective surgery to the lower limb received spinal anesthesia at a rate of approximately 0.1 mL/s using 0.5% tetracaine in 7.5% glucose with 0.125% phenylephrine in the lateral decubitus position with the operated side dependent. They were randomly divided into three groups: patients in Group I were placed supine immediately after spinal injection; those in Group II remained in the lateral position for 10 min before being turned supine; those in Group III were kept in the lateral position for 20 min then turned supine. Neural block was assessed by cold, pinprick, and touch sensation, and a modified Bromage scale. Hemodynamic variables included blood pressure, heart rate, and the use of ephedrine for the treatment of hypotension. The median (10th, 90th percentiles) peak dermatomal level to pinprick on the dependent side in Group III was T8 (T11, T5), which was significantly lower than that in Groups I and II, which extended to T4 (T9, T3) and T5 (T10, T2), respectively (P < 0.05). The difference in the maximal cephalad spread of sensory blockade between both sides in Group III was only one dermatome but was statistically significant (P < 0.05); in contrast, there was no significant difference in the maximal sensory level between both sides in Groups I and II. The use of ephedrine for the treatment of hypotension was significantly less frequent in Group III than the other groups. We conclude that keeping a patient in the lateral decubitus position for 20 min after hyperbaric tetracaine spinal anesthesia maintains preferential anesthetic distribution to the dependent side. Despite small differences between the two sides, the restricted spread of blockade and less hemodynamic variability may be clinically advantageous. IMPLICATIONS: The effects of posture on the spread of hyperbaric spinal anesthesia have not been adequately investigated. The results of the present study suggest an advantage of prolonged lateral decubitus positioning after intrathecal hyperbaric tetracaine.

Adolescent↗
PubMed2004

[Quality management in decubitus prevention].

Decubitus is one appropriate quality indicator in health care. Quality- or risk-management in the field of decubitus prevention is of interest for all involved professions. Nursing, medical and administrative staff are equally responsible. Data collection, evaluation and feedback aiming at the highest achievable benefit for patients and institutions are very important steps in the process. Suitable quality-programmes have been developed and implemented in Hamburg for hospitals and nursing facilities. Hence decubitus is discussed vividly and openly within a network of providers, research, sickness funds, insurance and politics.

Aged↗
PubMed1999

Influence of gravity on pulmonary venous flow velocity patterns: analysis of left and right pulmonary venous flow velocities in left and right decubitus positions.

BACKGROUND: The pulmonary venous flow signal measured by transesophageal echocardiography is generally recorded from the left upper pulmonary vein in the left lateral decubitus position, whereas that by transthoracic echocardiography is from the right upper pulmonary vein in the left semi-lateral decubitus position. The purpose of this study was to evaluate the influence of the postural change on the peak flow velocities of the left and right pulmonary veins and whether the parameters of the left and right pulmonary venous flow can be used interchangeably. METHODS AND RESULTS: The study group consisted of 37 patients with normal left ventricular filling pressure and in whom the systolic forward flow signals from both pulmonary veins recorded in the left and right lateral decubitus positions were clear enough to differentiate as biphasic. The peak early systolic (peak S1) and diastolic velocities were significantly increased when the pulmonary vein was on the recumbent subject's upper side, whereas the peak late systolic velocity (peak S2) was significantly increased when the pulmonary vein was on the recumbent subject's lower side. The peak S1 was higher than the peak S2 when the pulmonary vein was on the recumbent subject's upper side, whereas the reverse relation was seen when the pulmonary vein was on the recumbent subject's lower side. CONCLUSIONS: We should take into consideration the body position and the side on which the pulmonary vein is situated in evaluating the peak flow velocities of the pulmonary veins.

Adult↗
PubMed2001

Hemodynamic changes with right lateral decubitus body positioning in the tilted porcine heart.

BACKGROUND: In beating-heart coronary surgical procedures, exposure of posterior vessels through sternotomy causes cardiac function to deteriorate. We hypothesized that turning the subject to the right lateral decubitus position before cardiac retraction improves exposure of posterior vessels and preserves cardiac pump function on displacement. METHODS: Eight 80-kg open-chest pigs were instrumented with catheter-tip manometers. After a stepwise 60-degree turn to the right lateral decubitus position of the body, the heart was retracted anteriorly to 90 degrees with a suction stabilizer. RESULTS: Right lateral body positioning caused an approximately 45-degree right deviation of the apex, thereby exposing the left atrial groove. Stroke volume, mean arterial pressure, right atrial pressure, and right ventricular end-diastolic pressure increased to 106% +/- 5% (mean +/- standard error of the mean, p = 0.31), 106% +/- 3% (p = 0.01), 129% +/- 8% (p = 0.001), and 171% +/- 14% (p = 0.002), respectively, compared with control values. In contrast, left atrial pressure decreased to 73% +/- 6% (p = 0.007), whereas left ventricular preload remained unchanged (110% +/- 8%, p = 0.26). Additional anterior displacement to 90 degrees fully exposed the posterior vessels, and stroke volume decreased to 90% +/- 3% (p = 0.01) and mean arterial pressure to 93% +/- 5% (p = 0.07) at the expense of further increased right ventricular preload (256% +/- 28%, p < 0.001). CONCLUSIONS: By placing the subject in the right lateral decubitus position, exposure through sternotomy of posterior vessels in the beating porcine heart was facilitated while mean arterial pressure was maintained.

Animals↗
PubMed1982

Histopathology of the decubitus ulcer.

The histologic studies of the decubitus ulcer spectrum, which include blanchable erythema, nonblanchable erythema, decubitus dermatitis, decubitus ulcer, and the black eschar/gangrene reveal a dynamic process. The initial change occurs in the vessels of the papillary dermis. This is followed by necrosis of skin structures. The eschar/gangrene represents a full-thickness defect due either to prolonged ischemia and anoxemia or a sudden large vessel occlusion caused by shearing injury.

Adult↗
PubMedDate not supplied

Effect of left and right lateral decubitus positions on Doppler mitral flow patterns in patients with severe congestive heart failure.

Patients with severe congestive heart failure (SCHF) complain of increasing dyspnea when adopting left lateral decubitus (LLD) position that improves when turning over to the right lateral decubitus (RLD) position (trepopnea). We hypothesize that this clinical sign is due to changes in left ventricular (LV) preload and such changes would modify mitral flow. This study analyzes the effect of RLD and LLD positions on LV filling pattern assessed by Doppler echocardiography in patients with SCHF. Seventeen men and seven women (aged 56.22 +/- 18.52 years) with SCHF in New York Heart Association functional class III-IV and nine normal control subjects (eight men and one woman aged 56.96 +/- 18.14 years) were studied. We analyzed early (E) and late (A) LV filling velocities, E/A ratios, deceleration time, mitral time-velocity integral in each decubitus position, and the differences between them. Patients with SCHF have smaller mitral time-velocity integral, shorter deceleration time, greater E velocity and E/A ratio, and lower A velocity in LLD position than do normal control subjects. On assuming RLD position, patients with SCHF show decreases in E velocity and E/A ratio and lengthening of the deceleration time, suggesting a decrease in LV preload on changing position. This pathophysiologic mechanism may explain why patients with SCHF willingly adopt RLD position.

Adult↗
PubMed1997

Inhaled nitric oxide (40 ppm) during one-lung ventilation, in the lateral decubitus position, does not decrease pulmonary vascular resistance or improve oxygenation in normal patients.

OBJECTIVES: To determine the effects of inhaled nitric oxide (NO) on venous admixture (Qs/Qt), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance (PVR) in patients undergoing one-lung ventilation (1LV) in the lateral decubitus position. DESIGN: Prospective, blinded, crossover. SETTING: University hospital. PARTICIPANTS: Six adult patients scheduled for thoracotomy. INTERVENTIONS: Patients were anesthetized with thoracic epidural lidocaine, intravenous fentanyl, and inhaled isoflurane and were monitored with a systemic and pulmonary artery catheter (PAC). In the lateral decubitus position, the dependent lung was ventilated with 70% oxygen (O2) and 30% nitrogen (N2) for the control 1LV condition. For the experimental 1LV condition, the dependent lung was ventilated with the same gas concentration + NO at 40 ppm. Patients were alternated between the control and the experimental NO (40 ppm) conditions every 15 minutes for as long as the case would allow. MEASUREMENTS AND MAIN RESULTS: During all conditions, oxygenation, Qs/Qt, and pulmonary and systemic hemodynamics were measured in a double-blinded fashion. The mean PVR during 1LV was 128 +/- 39 (SD) dyne.s.cm(-5). Inhaled NO at 40 ppm did not affect MPAP, PVR, or Qs/Qt. CONCLUSIONS: Inhaled NO at 40 ppm, during 1LV in the lateral decubitus position, did not significantly decrease MPAP in patients with normal baseline PVR. Oxygenation and Qs/Qt did not change in this setting because MPAP was not altered. At present, interventions other than administration of inhaled NO should be applied to patients with normal PVR who experience hypoxia during one-lung ventilation.

Administration, Inhalation↗
PubMed1990

Proximal femurectomy for decubitus ulceration in the spinal cord injury patient.

The results of proximal femoral resections in nine patients were analyzed after an average four year follow-up, together with a retrospective analysis of the patients. The indication for surgery was decubitus ulceration that had failed to respond to multiple previous treatments. The decubitus ulcers were associated with septic arthritis, osteomyelitis, hip dislocation and ankylosis. All patients achieved short term healing with 50% achieving long term healing. The incidence of subsequent surgery for decubitus ulcers decreased significantly. No patient suffered a deterioration in function.

Adult↗
PubMed2001

Inflatable pillows as axillary support devices during surgery performed in the lateral decubitus position under epidural anesthesia.

UNLABELLED: The lateral decubitus position can cause dependent shoulder discomfort or result in traction on the brachial plexus. We measured pressure beneath the dependent shoulder and lateral angulation of the cervical spine in patients positioned in the lateral decubitus position for total hip replacement under epidural anesthesia. Inflatable pillows (Shoulder-Float) beneath the chest wall and head reduced pressure beneath the dependent shoulder from 66 to 12 mm Hg (P < 0.001) and lateral angulation of the cervical spine from 14 degrees to 4 degrees (P < 0.001). In a randomized crossover study of a further 15 patients, the use of inflatable pillows resulted in significantly less pressure beneath the dependent shoulder and chest wall than either a gel-pad or a 1000-mL lactated Ringer's bag. Inflatable pillows placed beneath the chest wall and head in the lateral decubitus position provided lower pressure beneath the dependent shoulder than other support devices and facilitated alignment of the cervical spine. IMPLICATIONS: When patients lie on their side, this results in pressure beneath the shoulder and tilting of the head and neck to one side. These problems were effectively corrected with an inflatable pillow (Shoulder-Float).

Adult↗
PubMed1988

Efficacy of the lateral decubitus position in preventing pneumothorax after needle biopsy of the lung.

We evaluated the efficacy of the lateral decubitus position in preventing the development of pneumothorax after percutaneous needle biopsy of a well defined lung lesion. Fifty patients had such a procedure and were immediately placed in the lateral decubitus position for ten minutes, with the biopsied lung below. A chest x-ray film was obtained after the ten minute period, four to six hours later, and on the following morning. The number of pneumothoraces and the type of treatment needed in each case were recorded. Results in these 50 patients were compared to those previously obtained in 132 patients who had had an identical procedure and follow-up during the preceding four years. In all patients included as controls, we did the biopsy using an identical technique and in accordance with a specific written protocol. Both groups of patients were closely comparable in age and sex distribution, baseline values for arterial blood gases, results of prebiopsy tests of pulmonary function, and type, size, location, and distance from the pleural surface of the pulmonary lesions. A postbiopsy pneumothorax developed in 21 of 50 (42%) study patients, and in 46 of 132 (35%) controls (P not significant). Specific therapy was needed in ten (48%) and 26 (56%) of these cases, respectively (P = NS). We conclude that placing patients in the lateral decubitus position is not effective in significantly reducing the incidence of postbiopsy pneumothorax or the proportion of patients who will require specific therapy for this complication.

Biopsy, Needle↗
PubMed1983

A randomized trial of cadexomer iodine in decubitus ulcers.

Thirty-four patients with decubitus ulcers were studied in a randomized trial to compare topical cadexomer iodine with the standard decubitus ulcer treatments used in the participating hospitals. There was a significant reduction of ulcer area with both treatments within three weeks; however, eight of 16 patients treated with cadexomer iodine had a reduction of ulcer area of more than 50 per cent, compared with one of 18 patients treated with the standard treatment (P less than 0.01). Twenty-seven patients continued the same treatment for five more weeks, during which time six in the cadexomer iodine group healed, compared with one in the standard treatment group (P less than 0.05). Cadexomer iodine was superior to the standard treatment in removing pus and debris from the ulcer surface and in reducing pain at the ulcer site. It was found to be easy both to apply and to remove from the ulcers and did not stain skin or clothing. Transient smarting during the first hour after application was reported by three patients, and one patient complained of skin irritation. The results show that cadexomer iodine applied daily has a debriding effect on decubitus ulcers and accelerates healing.

Administration, Topical↗
PubMed1990

Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index.

Biopsy of infected decubitus ulcers for culture disrupts tissues and may disseminate infection. Antimicrobial prophylaxis to prevent dissemination of infection may adversely affect biopsy culture results. Irrigation-aspiration to obtain submarginal specimens from draining decubitus ulcers was studied as an atraumatic, noninvasive culturing technique to serve as an alternative to biopsy in research activities. Two aspirates were obtained serially from 32 subjects; in 12 subjects, biopsies were also performed immediately. A median of 4.5 bacterial species was recovered per ulcer by irrigation-aspiration. Recent antimicrobial treatment had no evident effect on the recovery of bacterial species in general or, specifically, on the recovery of Bacteroides species. Concordance of results for both aspirates was 97.6% for aerobes and 91.8% for anaerobes, indicating no interactive methodological effect of the first irrigation-aspiration on the second. Compared with biopsy isolates for one aspirate, the sensitivity was 93% and the specificity was 99.0%; for another aspirate, the sensitivity was 94.7% and the specificity was 99.5%. The positive predictive value for either aspirate was greater than or equal to 93.9%. A weighted clinical index to score inflammatory ulcer characteristics was devised (score range, 0 to 15). In the absence of anaerobes in 15 subjects, the mean score was 6.1 +/- 3.5; in the presence of anaerobes in 17 subjects, the mean score was 9.4 +/- 3.2 (P = 0.008). The presence of aerobic gram-positive or gram-negative species did not significantly affect scores. Irrigation-aspiration for culture and clinical scoring of inflammation should permit independent serial measures of bacteriological and clinical courses of draining decubitus ulcers without patient risk or discomfort.

Aged↗
PubMed2005

Clindamycin-resistant Fusobacterium varium bacteremia and decubitus ulcer infection.

Bacteremia due to Fusobacterium spp. is unusual (<10% of cases of anaerobic bacteremia), and the isolation of Fusobacterium varium is especially uncommon. The most probable sources of Fusobacterium bacteremia are the respiratory, the gastrointestinal, and the genitourinary tracts. A.-M. Bourgault et al. (Clin. Infect. Dis. 25[Suppl. 2]:181-183) described 40 patients with Fusobacterium bacteremia; only 3 had Fusobacterium varium, and no one had decubitus scars as the portal of entry. In another published series (S. Henry, A. De Maria, and W. R. McCabe, Am. J. Med. 75:225-231, 1983) of 26 cases, two patients had concomitant pulmonary lesions and decubitus ulcers but there was no identification to the species level mentioned. We report a case of Fusobacterium varium bacteremia and infected sacral decubitus ulcer in an elderly patient.

Aged↗
PubMed1993

Pneumothorax: detection with upright versus decubitus radiography.

To evaluate the value of decubitus chest radiography in the clinical assessment of pneumothorax, the authors compared the detectability of pneumothorax on expiratory, upright chest radiographs with that on expiratory, lateral decubitus radiographs obtained with the suspected side up. Five radiologists reviewed 19 sets of radiographs with pneumothoraces and 20 sets of radiographs without pneumothoraces. All five radiologists were more accurate and had greater confidence in the evaluation of the upright studies. A pneumothorax was detected 21% (77 versus 57 of 95) more often on the erect radiographs. In three cases, however, decubitus positioning was more definitive. These results suggest that when clinically feasible, the expiratory, upright chest radiograph is the procedure of choice for the evaluation of small pneumothoraces.

Confidence Intervals↗
PubMed1985

Obesity alters regional ventilation in lateral decubitus position.

Alterations of regional ventilation were determined as a function of body position in five morbidly obese subjects using 81mKr to assess ventilation (V) and 127Xe at equilibrium to determine lung volume (V). With subjects in seated and supine positions, the left lung contributed an average of 43% of the total V/V. When the apical-basal gradient within each lung was examined in subjects in the seated position, V/V was greatest in the dependent (basal) regions in half of the subjects, whereas the others showed greater V/V near the upper lung regions. All obese subjects preferentially ventilated the nondependent lung in both the left and right lateral decubitus positions. In a control group of three nonobese subjects, V/V was found to be equally distributed between left and right lungs in both the seated and supine positions. In contrast with the results in the obese group, V/V was slightly greater in the dependent lung in both lateral decubitus positions. Although the combination of 127Xe images and He-dilution measurement of functional residual capacity in the lateral decubitus positions indicated a reduction in the volume of the dependent lung of the obese when compared with values in the seated position, other factors affecting the mechanical function of either the diaphragm or the intercostal muscles could also have produced these positional alterations of ventilation.

Adult↗
PubMed2005

Single-breath test in lateral decubitus reflects function of single lungs grafted for emphysema.

The slope of alveolar plateau for nitrogen derived from the single-breath test is useful to assess the function of bilateral lung grafts, but this technique is not applicable to patients with single-lung grafts due to the confounding influence of the native lung. We tested the hypothesis that the nitrogen slope measured in lateral decubitus with the graft in nondependent position may primarily reflect the distribution of ventilation in this lung. Fifteen patients with single-lung transplantation for emphysema, 10 healthy controls, and 7 patients with advanced emphysema performed single-breath washouts in right and left lateral decubitus; nitrogen slope was measured between 75 and 100% of expired volume. In 10 transplant recipients, the volume of each lung was measured in the two postures by computerized tomography. Nitrogen slope was unaffected by posture in normal controls and emphysema patients. On the other hand, nitrogen slope in transplant recipients was invariably smaller, with the graft in nondependent vs. in dependent position. Values of nitrogen slope with the graft in nondependent position were similar to those obtained in normal controls but significantly smaller than those obtained in emphysema patients. Computerized tomography studies in this position indicated that the volume expired below functional residual capacity was exclusively contributed by the graft. We conclude that, in patients with single-lung transplantation for emphysema, 1) measuring nitrogen slope in lateral decubitus allows to distinguish between the graft and the native lung, and 2) nitrogen slope obtained with the graft in nondependent position reflects ventilation distribution in this lung.

Breath Tests↗
PubMed1986

Value of chest ultrasonography versus decubitus roentgenography for thoracentesis.

Chest ultrasonography (CU) has been advocated as an effective tool for diagnosis and localization of pleural fluid. Studies to date supporting the technique have been anecdotal and nonrandomized. To determine if CU was beneficial when thoracentesis was performed by clinicians or house staff, we evaluated prospectively 205 patients presenting with pleural effusion at 2 community teaching hospitals. Decubitus roentgenograms were obtained on all patients, but CU with targeting by skin marker was performed on a randomized basis. Results were evaluated as to (1) whether the quantity of fluid obtained was sufficient for the intent of the procedure, (2) the number of needle insertions required to obtain the fluid, and (3) the incidence of complications such as pneumothorax. One hundred three effusions were evaluated by CU and 102 by roentgenography alone. The effusions in each group were stratified as small (obliteration of less than half of the hemidiaphragm on roentgenogram) or large. Small effusions were further stratified as free flowing or loculated (no layering of fluid on decubitus roentgenograms). By chi-square test, CU was significantly superior to decubitus roentgenograms alone for obtaining adequate fluid samples in small effusions (p less than 0.01). This was true regardless of whether the effusion was loculated (p less than 0.02) or free flowing (p less than 0.05). The technique had no such advantage in large effusions. We did not find that CU significantly reduced the need for multiple attempts nor incidence of complications in any group.

Drainage↗