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PubMed1986

Supine change in arterial oxygenation in patients with chronic obstructive pulmonary disease.

In normal subjects, recumbent PaO2 differs from upright PaO2 as a function of the relationship between FRC and closing volume. However, in patients with lung disease, the factors controlling PaO2 change. Furthermore, the distribution of airway closure does not strictly reflect gravitational gradients in pleural pressure. Hence, we evaluated the effects of recumbency on PaO2 in patients with advanced COPD. We conducted pulmonary function tests and measured PaO2, AaPO2, change from upright to supine FRC, VE, cardiac output (QT), and mixed venous oxygen saturation (SvO2). Eight patients with COPD in whom PaO2 decreased in the supine position (Group I) were compared with 8 patients with COPD in whom PaO2 improved in the recumbent position (Group II); the only anthropometric difference between the groups was greater body weight in Group II (p less than 0.05). Pulmonary function was comparable in the 2 groups. In both groups, FRC decreased with recumbency, but supine FRC and delta FRC did not differ between groups nor correlate significantly with PaO2, AaPO2, or venous admixture (QVA/QT). Supine SVO2 increased in both groups, but supine QT increased significantly only in Group I. In Group II, recumbent QVA/QT did not change significantly, whereas recumbent QVA/QT increased (p less than 0.02) in Group I. The cause for increased QVA/QT in Group I was reduced VE plus increased QT while supine; in contrast, by maintaining a higher supine VE and by not increasing QT significantly, an increase in QVA/QT was prevented in Group II subjects, an increase that would otherwise have overwhelmed the benefits of increased recumbent SVO2 on PaO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1984

Oxygen uptake kinetics of constant-load work: upright vs. supine exercise.

The purpose of this study was to compare oxygen uptake (VO2), O2 deficit, steady-state VO2, and recovery VO2 during the performance of a constant-load exercise in the supine and upright position. Ten male subjects (36-40 yr) performed one submaximal exercise test in the supine and one in the upright position consisting of 5 min rest, 5 min cycle ergometer exercise at 700 kg X min-1 and 10 min of recovery from exercise. The VO2 was measured continuously in all tests from 2-L aliquot air samples collected every 30 s. Steady-state VO2 was similar during supine and upright exercise. However, total VO2 during upright exercise was 0.30 L greater (p less than 0.05) than during supine exercise while O2 deficit and recovery VO2 in the upright position were 0.64 L and 0.22 L less (p less than 0.05) compared to the supine test. The larger O2 deficit during supine exercise resulted from a significantly greater VO2 halftime compared to that of the upright response. Despite the ability to eventually attain similar steady-state VO2, supine exercise results in a reduction of total VO2 capacity associated with an increase in the O2 deficit during submaximal constant-load exercise and manifested by elevated recovery VO2.

Adult↗
PubMed1984

Impairment of ventilatory function by supine posture in asthma.

Forced expiratory volumes were recorded in the upright position in 10 asthmatics before and after lying supine. On consecutive days were investigated, in random order, the effect of being supine for 0.5 h, 2 h, 4 h, and of being upright as a control experiment. Peak expiratory flow (PEF) was similarly recorded in the upright position, and, in addition, at every 0.5 h in the supine position. PEF decreased progressively in the supine position, but not in the control experiment. The decrease averaged 24% when supine for 4 h. After return to the upright position, it increased rapidly but incompletely. Forced expiratory volumes tended to decrease after being supine. Thus, the supine position may induce airflow obstruction in asthmatics, and posture may be a major factor behind nocturnal asthma. This protocol may be used as a bronchial challenge test in order to study possible influences on posture-induced obstruction in asthma.

Adult↗
PubMed1998

Dynamic displacement changes of the bladder neck with the patient supine and standing.

PURPOSE: With the patient standing and supine we determine the differences in dynamic changes of the bladder neck and directions of dynamic bladder neck displacement. MATERIALS AND METHODS: To evaluate the dynamic movement of the bladder neck we recruited into the study 78 consecutive women 27 to 69 years old with various urogynecological complaints. The anatomical changes of the bladder neck from rest to maximal straining and from rest to holding were evaluated and compared with the patients supine and standing. RESULTS: Except for bladder neck rotational angle with the patient standing, all parameters were significantly different from corresponding measurements with the patient supine. Mean rotational angle of rest to maximal straining plus or minus standard deviation was 39.4 +/- 18.9 degrees when standing versus 39.8 +/- 23.4 degrees when supine (p > 0.05). The distances between the bladder neck and symphysis pubis at rest, and during maximal straining and holding the bladder neck in the supine position were significantly longer than those in the standing position. The direction of bladder neck displacement from rest to maximal straining was more caudad and ventral when standing. The bladder neck moved cephalad and ventral when the patient was standing, and cephalad and dorsal with the patient supine and holding the bladder neck. CONCLUSIONS: The anatomical locations and dynamic displacements of the bladder neck at rest, and during maximal straining and holding were significantly different in the supine and standing positions. While evaluating the dynamic motion of the bladder neck to determine bladder neck mobility, patient position must be considered and specified in accordance with diagnostic standards.

Adult↗
PubMed1998

Supine empty stress test as a predictor of low valsalva leak point pressure.

Our objective was to determine whether a positive supine empty stress test is predictive of a low Valsalva leak point pressure (< or =60 cm of water). Evaluation was carried out on 179 patients with a history of genuine stress incontinence confirmed with urodynamic testing. All patients had a supine stress test performed after voiding. Residual urine determinations were all <100 cc. A vesical Valsalva leak point pressure determination (cough and strain) was performed during multichannel urodynamics with 150 cc in the bladder. Urethral profilometry was performed at maximum capacity. There was a statistically significant relationship between a low leak point pressure and a positive supine empty stress test (P < 0.000). The supine empty stress test had a sensitivity of 79% and a specificity of 62.5% for the detection of a low leak point pressure. The negative predictive value was high at 90%. For the age group 50 years and younger the negative predictive value was 95%. However, there was no significant relationship between a positive supine empty stress test and a low maximal urethral closure pressure. We conclude that the supine empty stress test is a useful screening test for a low leak point pressure but not a low urethral closure pressure. Its high negative predictive value is useful in excluding the presence of a low leak point pressure and may help the clinician to determine which patients with genuine stress incontinence need further assessment of the dynamic function of the urethral sphincter.

Exercise Test↗
PubMed2003

Pulmonary gas trapping increases in asthmatic children and adolescents in the supine position.

This study aimed to see if gas trapping or ventilation inhomogeneity during tidal breathing increases in young asthmatic subjects when recumbent over a period of 1 hr. Ten asthmatic children and teenagers and 12 control subjects performed tidal breathing multiple-breath N(2)-washout in the sitting position and immediately, 30 min, and 60 min after assuming the supine position. The asthma group also performed the same lung function tests on another day, but then remained in the sitting position throughout. When assuming the supine position, both groups showed significant falls in vital capacity (4-8%) and in functional residual capacity (FRC) (>20%). Gas trapping increased significantly after 30 and 60 min in the supine position only in the asthma group, but other indices of ventilation inhomogeneity did not change with body position. When in the supine position, the trapped gas volume was on average 10% of FRC in the asthma group, which was twice as much as when sitting and three times higher than in supine control subjects. It is concluded that assuming the supine position leads to increased gas trapping in young asthmatics but not in healthy subjects; this could be one of several mechanisms that contribute to nocturnal worsening of asthma.

Age Distribution↗
PubMed2001

Supine hypoxemia following nebulizated salbutamol in patients with chronic airway obstruction.

Inhaled beta-adrenergic agonists can decrease arterial oxygen tension (PaO2). A decrease in PaO2 can also be observed with supine posture. We assessed the effect on PaO2 of supine posture following salbutamol nebulization inpatients with chronic airflow obstruction. Twelve patients (10 males, 2 females mean age 60 yr) with FEV1/FVC = 0.65 (mean 0.54) and resting PaO2 = 60 mm Hg while breathing room air (mean 76.5 mm Hg) were included in a prospective randomized double-blind double crossover study conducted for 2 consecutive days. On each study day, each patient successively underwent baseline PaO2 measurement; nebulization of either salbutamol (0.5% solution, 1 cm3) or saline; two supervised 30-min periods in the supine or seated posture, with PaO2 measurement at the end of each period. PaO2 values were compared with analysis of variance for repetitive measurements (6 values for each patient). PaO2 values (mean +/- SD; mm Hg) were similar at baseline (day 1: 76.5 +/- 8.1; day 2: 76.6 +/- 8.6), after saline + seated (74.8 +/- 7.2), after saline + supine (74.9 +/- 7.5), and after salbutamol + seated (74.3 +/- 7.3). In contrast, PaO2 after salbutamol + supine (70.8 +/- 10.1) was significantly lower than all other values (p <0.05), six patients exhibited large PaO2 decreases (from 9 to 21 mm Hg). Hypoxemia induced by the combination of nebulized salbutamol and supine posture may represent a potential hazard of bronchodilator therapy.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Cardiac size in the supine chestfilm.

The aim of this study was to find a normal value for the cardiac size in the supine position because such a standard is hardly known in the literature. Cardiac size in the erect and supine positions were compared in 165 patients in whom both chest radiographs were performed prior to kidney transplantation. For cardiac size as well as for cardiothoracic ratio (CTR) there is a linear relation between the measured values in the two positions which allows to determine the cardiac size in the supine position from a radiograph taken in the erect position and thus to determine whether cardiac enlargement exists in a supine chest film. A survey of 100 patients without cardiac or pulmonary pathology showed 16 patients with a heart size over 15 cm, the upper limit of normal as established over 20 years ago, which suggests that nowadays a new standard might be set. If so, the upper limit of normal CTR is 0.55 in the erect and 0.58 in the supine position. Two figures are presented to determine cardiac size and CTR in the supine position from the measured values in the erect position and vice versa.

Adolescent↗
PubMed2006

Unloading reaction to electrical stimulation at neutral and supinated ankle positions.

An unloading reaction has been characterized as a modified flexor reflex (FR), in which the standing subjects decrease the load on the stimulated foot and increase the load on the contralateral side, but, without withdrawal of the stimulated foot. Different behavioral circumstances have been shown to modulate this reflex. It is not known whether unloading reactions can be modulated with a loaded supinated ankle position, which, in excess, may result in an ankle sprain injury. Since ankle sprain depends on the load applied to a supinated foot, our premise is that unloading reactions may protect the ankle from a sprain injury. Therefore, this study investigated how the unloading reactions were modulated during a loaded supinated ankle condition. We delivered non-nociceptive and nociceptive electrical stimulations on the lateral aspect of the ankle in standing subjects with the foot in neutral and in a supinated position. The magnitude and latencies of reflex responses were registered using kinetic and kinematic analyses and subsequently compared among the conditions. The analysis demonstrated greater reactions for the supinated ankle condition. The individuals also moved their whole body downwards and shifted the body weight to the non-stimulated foot. Therefore, this study suggested that a modified type of the classic flexion reflex, i.e., unloading reaction, may be used as a strategy to unload a supinated ankle and potentially minimize the risk of ankle sprain injuries.

Adult↗
PubMed2006

Dosimetric and toxicity comparison between prone and supine position IMRT for endometrial cancer.

PURPOSE: To determine the dosimetric and toxicity differences between prone and supine position intensity-modulate radiotherapy in endometrial cancer patients treated with adjuvant radiotherapy. METHODS: Forty-seven consecutive endometrial cancer patients treated with adjuvant RT were analyzed. Of these, 21 were treated in prone position and 26 in the supine position. Dose-volume histograms for normal tissue structures and targets were compared between the two groups. Acute and chronic toxicity were also compared between the cohorts. RESULTS: The percentage of volume receiving 10, 20, 30, 40, 45, and 50 Gy for small bowel was 89.5%, 69%, 33%, 12.2%, 5%, and 0% in the prone group and 87.5%, 62.7%, 26.4%, 8%, 4.3%, and 0% in the supine group, respectively. The difference was not statistically significant. The dose-volume histograms for bladder and rectum were also comparable, except for a slightly greater percentage of volume receiving 10 Gy (1.5%) and 20 Gy (5%) for the rectum in the prone group. Acute small bowel toxicities were Grade 1 in 7 patients and Grade 2 in 14 patients in the prone group vs. Grade 1 in 6 patients and Grade 2 in 19 patients in the supine group. Chronic toxicity was Grade 1 in 7 patients and Grade 3 in 1 patient in the prone group and Grade 1 in 5 patients in the supine group. CONCLUSION: These preliminary results suggest that no difference exists in the dose to the normal tissue and toxicity between prone and supine intensity-modulated radiotherapy for endometrial cancer. Longer follow-up and more outcome studies are needed to determine whether any differences exist between the two approaches.

Adult↗
PubMed2006

Can a finite set of knee extension in supine position be used for a knee functional examination?

The kinematic magnetic resonance imaging technique has been developed to provide a functional examination of the knee. Technical limitations require this examination to be performed in supine position, and the knee motion is represented by an assembly of static positions at different knee angles. However, the main knee function is to support the body weight and perform continuous motion, e.g. parallel squat. Our study quantified the knee kinematics of 20 healthy subjects in different motion conditions (finite and continuous) and in different mechanical conditions (continuous unloaded and continuous loaded). We evaluated the angular and localisation difference of a finite helical axis of the knee motion for parallel squat, continuous knee extension in supine position and the finite set of knee extension in supine position. We found large inter-individual dispersion. The majority of subjects had equivalent knee kinematics between continuous knee extension and the finite set of knee extension in supine position, but not between continuous knee extension in supine position and the parallel squat. Therefore, results from a functional examination of a finite set of knee extensions in supine position do not represent the knee motion in a parallel squat. Our results suggest that functional examination of the knee from magnetic resonance imaging do not necessarily reflect the physiological kinematics of the knee. Further investigation should focus on a new magnetic resonance imaging acquisition protocol that allows image acquisition during weight bearing or includes a special device which reproduces the loaded condition.

Adult↗
PubMed1998

Goniometric assessment of shoulder range of motion: comparison of testing in supine and sitting positions.

OBJECTIVE: To examine intrarater reliability in measurements of active range of motion and passive range of motion of shoulder flexion and abduction when motions are assessed in sitting, as compared with supine. DESIGN: Thirty adult subjects were measured eight times, in random order, for each of the two shoulder motions: two passive and two active measurements while sitting, and two passive and two active measurements while supine. Data were analyzed to determine intraclass correlation coefficients (ICCs) and paired t values between trials 1 and 2 for measurements in the same position, and between sitting and supine trials for each type of measurement. SETTINGS: Rehabilitation facility and university. STUDY POPULATION: Volunteer sample: 11 rehabilitation inpatients; 19 university students. RESULTS: ICCs between trials 1 and 2 on comparable measurements in the same position indicated high intrarater reliability for active and passive measurements, regardless of testing position. ICCs between comparable measurements in the two testing positions indicated only a moderate level of agreement. Paired t tests between comparable readings taken in sitting versus supine revealed no significant differences for flexion, but significantly higher measurements of abduction when testing in the supine position. CONCLUSIONS: Measurements in sitting or supine yield similarly high intrarater reliability. Lowered reliability between measurements taken in different positions indicates that test position should be routinely recorded, and repeated clinical measures of individual subjects should be administered in a consistent position.

Adolescent↗
PubMed1995

Vulnerability of respiratory control in healthy preterm infants placed supine.

OBJECTIVE: We tested the hypothesis that healthy preterm infants have attenuated ventilatory responses to hypercapnia, associated with a decreased rib cage contribution to ventilation, in the supine versus prone position. STUDY DESIGN: We elicited hypercapnic ventilatory responses from 19 healthy preterm infants (postconceptional age 35 +/- 1 weeks) who were being prepared for hospital discharge. The O2 saturation was continuously monitored. Before and during CO2 rebreathing, ventilation was measured with a nasal mask pneumotachygraph and was derived from chest wall motion as determined by respiratory inductance plethysmograph. This measuring method allowed us to compare both ventilation and the percentage rib cage contribution to ventilation between supine and prone positions. Statistical analysis employed analysis of variance with repeated measures. RESULTS: The supine position was associated with a higher respiratory rate (p < 0.02) and lower O2 saturation (p < 0.007) than the prone position. The increase in ventilation in response to hypercapnia was lower in the supine than in the prone position. This was statistically significant for the respiratory inductance plethysmograph (p < 0.008) but not the pneumotachygraph (p = 0.077), and was associated with a smaller rib cage contribution to ventilation in the supine than in the prone position (p < 0.0001). CONCLUSION: Respiratory control may be vulnerable when healthy preterm infants are placed supine. Widespread avoidance of the prone position may not be appropriate for such patients.

Carbon Dioxide↗
PubMed1998

Body composition assessment by dual-energy x-ray absorptiometry: comparison of prone and supine measurements.

The aim of the study was to assess whether changes in the interposition of body compartments affect the results of body composition measurements by dual-energy x-ray absorptiometry (DEXA) in the fan-beam mode. Thirty healthy subjects underwent two sequential measurements: the first was performed in the supine position as described by the manufacturer, and the second in the prone position. Estimates of body composition were compared between the two measurements. Mean body weight did not differ between measurements ([mean+/-SD] supine vprone, 68.561+/-12.461 v 68.589+/-12.469 kg). Mean bone mineral content (BMC) was lower in the prone position versus the supine position. When the head was excluded, this difference reached statistical significance (supine v prone, 1,738+/-361 v 1,688+/-360 g, P=.0001). The mean fat tissue mass (FTM) was lower and lean tissue mass (LTM) higher in the prone measurements. When the head was excluded, the mean FTM difference between the two measurements became greater (FTM supine v prone, 25.129+/-10.445 v 24.030+/-10.388 kg, P=.0001; LTM supine v prone, 37.309+/-9.357 v 38.246+/-9.150 kg, P=.0001). It is concluded that the positioning of the patient on the examination table affects DEXA body composition measurements by the fan-beam mode. This could imply a lack of accuracy of the method, which may be due to subtle changes in regional tissue depth and fat distribution caused by patient repositioning.

Absorptiometry, Photon↗
PubMed2002

Mechanisms of ventilation inhomogeneity during vital capacity breaths standing and supine.

Overall inhomogeneity of ventilation distribution, as measured by single-breath vital capacity (VC) washout (SBW) is known to be greater supine vs. standing. To establish the underlying mechanisms 13 healthy males performed VC SBW of 4% SF(6) and He, standing and supine, with or without a 10 sec breathhold (BH). Overall inhomogeneity, as indicated by normalized phase III slopes, was >50% greater supine (SF(6) 13.1 x 10(-3); He 10.7 x 10(-3) L(-1)) than standing (SF(6) 8.6 x 10(-3); He 6.4 x 10(-3) L(-1); P<0.001). The (SF(6)-He) slope, an index of intraacinar inhomogeneity, did not change with posture. Breathholding, assumed to eliminate convective dependent inhomogeneity within and/or between small lung units, produced twice as great reduction of inhomogeneity when supine vs. standing. After BH inhomogeneity remained significantly greater supine vs. standing. In conclusion, at least two events seem to underlie the increased inhomogeneity when supine: (1) a substantially increased convection dependent non-uniformity between well-separated lung regions; and (2) a somewhat increased convection dependent non-uniformity within and/or between peripherally located lung units.

Adult↗
PubMed2002

Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique.

OBJECTIVES: To compare the results of percutaneous nephrolithotomy in the supine and prone positions. METHODS: A total of 130 patients who underwent percutaneous nephrolithotomy for renal or upper ureteral stones were evaluated in a prospective and nonrandomized manner. The procedure was carried out in the supine or prone position in 53 and 77 patients, respectively. The results in both positions were compared regarding the technical aspects, success rate, and morbidity. RESULTS: Regardless of the position, the pelvicaliceal system could be successfully approached in all patients, and the posterior calices were the most common site of entry. Punctures through the anterior calices were more frequently reported with the supine position. A higher incidence of anteromedial displacement of the kidney during tract dilation was reported with the supine approach. The overall success rate was 89% and 84% in the supine and prone positions, respectively. The complication rates were similar in both groups, and none of the patients experienced injury of adjacent organs. CONCLUSIONS: The approach to the pelvicaliceal system is feasible in the supine position. The success and complication rates are comparable to the prone approach.

Adult↗
PubMed1999

Internal organ motion in prostate cancer patients treated in prone and supine treatment position.

BACKGROUND AND PURPOSE: To compare supine and prone treatment positions for prostate cancer patients with respect to internal prostate motion and the required treatment planning margins. MATERIALS AND METHODS: Fifteen patients were treated in supine and fifteen in prone position. For each patient, a planning computed tomography (CT) scan was used for treatment planning. Three repeat CT scans were made in weeks 2, 4, and 6 of the radiotherapy treatment. Only for the planning CT scan, laxation was used to minimise the rectal content. For all patients, the clinical target volume (CTV) consisted of prostate and seminal vesicles. Variations in the position of the CTV relative to the bony anatomy in the four CT scans of each patient were assessed using 3D chamfer matching. The overall variations were separated into variations in the mean CTV position per patient (i.e. the systematic component) and the average 'day-to-day' variation (i.e. the random component). Required planning margins to account for the systematic and random variations in internal organ position and patient set-up were estimated retrospectively using coverage probability matrices. RESULTS: The observed overall variation in the internal CTV position was larger for the patients treated in supine position. For the supine and prone treatment positions, the random components of the variation along the anterior-posterior axis (i.e. towards the rectum) were 2.4 and 1.5 mm (I standard deviation (1 SD)), respectively; the random rotations around the left-right axis were 3.0 and 2.9 degrees (1 SD). The systematic components of these motions (1 SD) were larger: 2.6 and 3.3 mm, and 3.7 and 5.6 degrees, respectively. The set-up variations were similar for both treatment positions. Despite the smaller overall variations in CTV position for the patients in prone position, the required planning margin is equal for both groups (about 1 cm except for 0.5 cm in lateral direction) due to the larger impact of the systematic variations. However, significant time trends cause a systematic ventral-superior shift of the CTV in supine position only. CONCLUSIONS: For internal prostate movement, it is important to distinguish systematic from random variations. Compared to patients in supine position, patients in prone position had smaller random but somewhat larger systematic variations in the most important coordinates of the internal CTV position. The estimated planning margins to account for the geometrical uncertainties were therefore similar for the two treatment positions.

Algorithms↗
PubMed2003

Influence of the pronator quadratus and supinator muscle load on DRUJ stability.

PURPOSE: To determine the effects of altering the load contributions of the pronator quadratus and supinator muscles on in vitro distal radioulnar joint (DRUJ) stability during pronation and supination and before and after ulnar head excision. METHODS: Multiple pronation trials were conducted with incremental loading of the pronator quadratus relative to the pronator teres muscle; supination trials were similarly conducted with incremental loading of the supinator relative to the biceps muscle. All trials were conducted using an upper-limb apparatus capable of simulating muscle/tendon loading and displacement. Stability measurements included dorsal-volar translations of the radius relative to the ulna and DRUJ diastasis and convergence. RESULTS: Increased pronator quadratus loading did not affect intact DRUJ stability but effects were noted after ulnar head excision when the forearm was positioned between neutral and full pronation. Incremental loading of the supinator muscle did not modify DRUJ stability in the intact or ulnar head excised state. CONCLUSIONS: Pronator quadratus muscle activity aggravates forearm instability after ulnar head excision. Immobilization of the forearm in mid- to full supination should minimize pronator quadratus activity and optimize soft-tissue healing. This information may be useful to develop in vitro muscle-loading scenarios and analytical forearm models.

Aged↗