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PubMed1982

Position may stop pneumothorax progression in dogs.

We attempted to see what the effect of position was on the rate of pneumothorax formation. In 6 anesthetized spontaneously breathing dogs in the left decubitus position, a chest tube was inserted into the right hemithorax. A right-sided pneumothorax was induced by percutaneous transthoracic insertion of a 20-gauge needle into the lung. Once a constant rate of pneumothorax formation occurred, the dogs were alternated between 3 min of no evacuation by the chest tube with the puncture site up (left decubitus) or down (right decubitus). The pneumothorax that accumulated was always evacuated immediately thereafter with the chest tube in the highest position (left decubitus). In every case, the rate of pneumothorax formation decreased with the puncture site down rather than with it up. Furthermore, this maneuver caused the site of leak to completely seal 11 of 21 times in which the puncture site was placed dependent. There was, however, no significant change in the rate of pneumothorax formation with the puncture site kept in the nondependent position. These results are consistent with the hypothesis that placing the site of pleural gas leak in the most dependent position causes a reduction in alveolar size as well as the alveolar to pleural pressure gradient in the region surrounding the leak. Both of these factors would tend to slow the rate of pneumothorax formation and allow sealing of the puncture site.

Animals↗
PubMed1993

Effect of body position on gas exchange in patients with unilateral central airway lesions. Down with the good lung?

In this study, we evaluated the effect of body position (erect, supine, and two decubitus positions) on gas exchange (alveolar-arterial PO2 difference [AaPO2]) in 35 patients who had various degrees of lung collapse roentgenographically caused by unilateral central airway lesions, with special reference to the difference in AaPO2 between two lateral decubitus positions. The patients were divided into two groups. Group 1 was composed of 23 patients with FEV1/FVC > 70 percent. In group 2, there were 12 patients with FEV1/FVC < 70 percent. Our results showed that the mean AaPO2 of group 1 patients was least in the lateral decubitus position with normal lung down (AaPO2N), followed by those in the supine position (AaPO2S), in the lateral decubitus position with lesioned lung down (AaPO2L), and in the erect position (AaPO2E). There was no significant difference in AaPO2 obtained in four positions. However, a significantly negative correlation was found between AaPO2NL (AaPO2N minus AaPO2L) and patient's FEV1 (p < 0.05). In group 2 patients, the mean AaPO2E was least, followed by AaPO2L, AaPO2N, and AaPO2S. The changes of body position did not significantly affect gas exchange in group 2 patients. Unlike previous reports, the present study showed that AaPO2N was not exclusively less than AaPO2L in our patients. AaPO2N was higher than AaPO2L in 11 of 23 in group 1 and in 5 of 12 in group 2 patients. In summary, our results indicated that positional changes did not significantly affect gas exchange in the patients with lung collapse roentgenographically caused by unilateral central airway lesions and the dogma "Down with the good lung" could not be applied to these patients flawlessly.

Aged↗
PubMed2000

Stereotactic breast biopsy: recumbent biopsy using add-on upright equipment.

OBJECTIVE: The purpose of the study was to show that stereotactic breast biopsy can be performed effectively and accurately using add-on stereotactic equipment when it is performed with the patient in a decubitus or recumbent position. MATERIALS AND METHODS: We retrospectively reviewed the results of 225 stereotactic core breast biopsies performed during a 42-month period. The biopsies were performed using a reclining mammography chair and add-on stereotactic equipment. Procedures were performed with the patient in the right or left lateral decubitus position or upright. Patients with benign biopsy results were followed up mammographically at 6 months initially, then yearly. RESULTS: Of the 225 lesions biopsied stereotactically, 205 lesions (91%) were biopsied with the patient in the decubitus (right or left) position and 20 (9%) biopsied with the patient upright. Pathology results were classified as abnormal in 45 lesions (20%) and normal in 180 lesions (80%). All but one of the abnormal lesions were followed up with surgical excision. One hundred thirty-four of the 180 benign lesions have been followed up with at least one 6-month mammogram (follow-up range, 6-40 months), and none of the lesions has been subsequently proven malignant. CONCLUSION: Stereotactic core biopsy can be performed effectively and accurately using standard add-on equipment when it is performed with the patient in the decubitus position. This approach obviates the use of dedicated prone stereotactic equipment.

Biopsy, Needle↗
PubMed1986

Positional effects on distribution of ventilation in chronic obstructive pulmonary disease.

Ventilation is distributed predominantly to the dependent lung in normal persons in the decubitus position. We evaluated the distribution of ventilation in four patients with mild-to-moderate chronic obstructive pulmonary disease using 81mKr gas. Patients were tested in the sitting and right and left decubitus positions with and without the application of positive end expiratory pressure (PEEP). In contrast to findings in controls, ventilation was predominantly distributed to the nondependent lung in patients in the decubitus position. Mean ventilation in the right lung decreased from 51% of the total in the sitting position to 31% in the right decubitus position; it increased with the application of 10 cm PEEP. Reduced ventilation in the dependent lung most likely is caused by closure of the airways after a decrease in volume. Application of PEEP resulted in increased lung volume and preferential distribution of ventilation to the dependent lung.

Aged↗
PubMed2003

Patient positioning after lung biopsy: influence on the incidence of pneumothorax.

OBJECTIVE: To determine if post-biopsy complication rates were influenced by patient positioning after the procedure. METHODS: A prospective evaluation of post-biopsy complications in 87 patients (55 men, 32 women; mean age 66 yr, range 20-86 yr) undergoing fine-needle aspiration biopsy of lung nodules was performed. Biopsies were performed under computed tomographic guidance in 66 patients, fluoroscopic guidance in 18 and ultrasonographic guidance in 3 patients. Patients were randomly assigned to be placed either in the lateral decubitus "biopsy-side-down" position or in the "biopsy-site-dependent" position (i.e., lying directly on the skin puncture site) after surgery. Chest imaging was performed immediately and at 4 hours after biopsy. RESULTS: Immediately after the procedure, 6 (14%) of the 42 patients in the decubitus biopsy-side-down group and 15 (33%) of the 45 patients in the site-dependent group experienced pneumothoraces (p > 0.05). No patient required tube thoracostomy. Two patients in the decubitus group and 1 in the site-dependent group experienced hemoptysis immediately after biopsy. On the 4-hour chest radiographs, there was no progression in size of the existing pneumothoraces. CONCLUSION: Positioning the patient either decubitus biopsy-side-down or lying directly on the puncture site after lung biopsy does not appear to affect complication rates.

Adult↗
PubMedDate not supplied

Effects of posture change on the hemodynamics of the liver.

BACKGROUND/AIMS: According to our experience, blood flow in the portal vein may alter according to body posture. It is reported that decreased portal venous flow immediately gives rise to significantly increased blood flow in the hepatic artery. To gain further insight into blood flow changes affected by posture, we examined blood flows in the portal vein, hepatic artery and hepatic vein at different postures. METHODOLOGY: Using a Doppler ultrasound system, the hemodynamics of the portal vein, right hepatic artery, and hepatic vein were examined in 35 patients at supine and left decubitus positions. RESULTS: Portal vein blood flow volumes were significantly lower in the left decubitus position than in the supine. In the right hepatic artery, the left decubitus position gave significantly higher blood flow velocity values than the supine. CONCLUSIONS: Our results indicated that upon change of posture from the supine to left decubitus position, portal vein flow velocity was reduced and hepatic artery flow velocity increased. Changes in portal and hepatic arterial flows by changing posture may be explained by decreased portal flow as a direct result of changed posture, leading to increased hepatic arterial flow to maintain total hepatic blood inflow.

Aged↗
PubMedDate not supplied

[Postural rhinomanometry in normal subjects].

Measurement of decubitus-caused variations in air flow resistance through the nasal cavities indicates the vascular reactivity of turbinate cavernous tissue and makes it possible to evaluate the variable component in nasal resistance; a component usually suppressed by previous pharmacological vasoconstriction. The aim of the present work has been to indicate normative values regarding variations in nasal resistance in different types of decubitus. The latter will be referenced for future studies regarding nasal vasomotor pathologies (specific or aspecific hyperreactivity). Eighty nasal cavities from normal subjects were examined by means of Anterior Active Rhinomanometry in the following positions: seated, supine, homolateral and contralateral to the fossa in question. As absolute values are highly variable even in normal subjects, the resistance variations in decubitus were expressed in percentage of basal value (seated position). In every decubitus there is an average increase in resistance due to the increased venous pressure in the cephalic area although the greatest statistical significance and lowest scattering of values is found in the supine position with 20 degrees head-trunk angle. Mean values and standard deviations are given and will be referenced for further studies on rhinopathology.

Adult↗
PubMedDate not supplied

[Gastric emptying in children. VII. Influence of body posture, using an oral hydration solution as the test meal].

Twenty four infants and children of both sexes with age ranging from 1 day to 18 months, and weighing between 2700 g and 10000 g, were studied. There were several reasons for admission; but during performance of the tests they were in complete recuperation of their illness and there was no evidence of gastrointestinal disturbs. Four gastric emptying studies were performed in every subject, in consecutive days, between 10 to 12 A.M. A nasogastric tube was used for injecting the test meals; these consisted of a dilute solution of phenolsulfonphthalein in a hydration oral solution recommended by W. H. O. Residual gastric volume was measured at the "free" position (without contention), and supine, right and left lateral decubitus, when the subjects were immobilized with a sheet. The test's sequence was aleatory. Our data allows us to conclude that the child's decubitus has an influence on gastric emptying when using the W.H.O. solution for oral hydration. Although no differences were observed, among the "free" position, right lateral and supine decubitus, the gastric emptying in the left lateral decubitus was significantly retarded. Even though this study has been carried among children without diarrhea or dehydration we still advise rapid gastric emptying position during rehydration in these little patients.

Female↗
PubMed1986

[Pericardial defect: roles of the pericardium on kinetoanatomic changes of the heart influenced by patients' postures].

To elucidate the physioanatomic roles of the pericardium, the alterations in gross anatomy and cardiac motion induced by posture were examined by two-dimensional echocardiography in seven patients with total absence of the left pericardium. Ten healthy subjects were served as controls. The heart was located deeper within the chest at end-diastole in patients with pericardial defect than in healthy subjects, especially in the left lateral decubitus position. With progression of systole, the cardiac apex swung anteriorly with the cardiac base as the fulcrum, and the heart approximated the normal position at end-systole. The deeper the position of the center of the cross-section of the left ventricular cavity at end-diastole, the more exaggerated the swinging motion in systole. The deep location of the heart in end-diastole is considered to result from release from pericardial support, and the systolic tonus of the cardiac muscle restores the apex to nearly normal position. The characteristic swinging motion of the heart and its alterations dependent of posture seemed the signs suggestive of total absence of the pericardium. The shape of the short-axis view of the left ventricular cavity was nearly circular throughout the cardiac cycle. Therefore, paradoxical motion of the ventricular septum observed on M-mode echocardiography in pericardial defect results from the anterior shift of the entire heart overcoming the proper motion of the interventricular septum. The left ventricular dimension become enlarged according to the postural change from the right to left lateral decubitus positions regardless of the presence or absence of the pericardium. The right ventricular cavity became enlarged in the left lateral decubitus position in patients with pericardial defect. The elevation of hydrostatic pressure due to postural change was considered excessive due to the absence of the pericardium. In the left lateral decubitus position, systolic excursions of the mitral and tricuspid rings became more prominent in healthy subjects, whereas these excursions, particularly of the tricuspid ring, were reduced in patients with pericardial defect. Depressed tricuspid ring motion was also observed in the right lateral position in cases with pericardial defects. The reduced excursion of the tricuspid, ring and the right ventricular dilatation may affect systemic venous return to the right atrium.

Adult↗
PubMed1982

Bacterial infections in patients with chronic renal failure: occurrence with spinal cord injury.

The available data were examined from 43 patients with spinal cord injuries and end-stage renal disease undergoing dialysis. All but one patient had a chronic urinary tract infection, which was characterized by persistence of the same organisms for prolonged periods, high prevalence of mixed infections, scarcity of symptoms, lack of fever of leukocytosis, and a considerable prevalence of cross-infection with the decubitus ulcers. Staphylococcus aureus and various Gram-negative organisms were responsible for most of the vascular access infections in our patients. Decubitus ulcers were common and were frequently infected. Cross-contamination between infected decubitus ulcers, the urinary tract, and vascular access seemed to have occurred on several occasions. The recorded respiratory infections were preponderantly caused by Gram-negative organisms. Urinary tract, vascular access, and decubitus infections seemed to be the source of septicemia in most of the recorded instances. Septicemia was the immediate cause of death in half of the patients.

Adult↗
PubMedDate not supplied

[Continuous monitoring of hemoglobin oxygen saturation in mixed venous blood during thoracic anesthesia with selective single-lung ventilation].

OBJECTIVES: The lateral decubitus position, the thoracotomy and selective single-lung ventilation all cause serious changes in oxygenation. The aim of this study is to examine the usefulness of continuous monitoring of mixed venous saturation (SvO2) under these conditions. MATERIAL AND METHODS: Twenty-three patients scheduled for pulmonary resection by thoracotomy in lateral decubitus position with single-lung ventilation were monitored continuously for SvO2 by reflection oximetry and a fiber-optic catheter in the pulmonary artery (Abbot Oximetrix 3). Cardiorespiratory profiles were obtained 15 minutes after induction (M1), after 15 minutes in lateral decubitus position (M2), 5 min after start of pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6), and after 5 min in supine decubitus position (M7). RESULTS: The decrease in SvO2 was not statistically significant. It reached its lowest level at M5 and rose significantly in M6 (p < 0.05). For all SvO2 measurements there was a significant correlation between Oximetrix 3 and Co-oximeter readings. C(a-v)O2 and O2 uptake correlated significantly at all measurements, as did those of PvO2 and Qva/Qt except at M6. VO2I correlated inversely from M1 to M5, and CI an DO2I only at M6 and M7. PaO2 and SaO2 were significantly correlated during single-lung ventilation (M4 and M5) and later (M6). The combined changes in SaO2(a-v) and CI explain the changes in SvO2 only during and after selective ventilation, and the changes are more likely to be reflected by SaO2 than by CI. CONCLUSIONS: Under the conditions studied, continuous monitoring of SvO2 is a reliable method, indicating primarily oxygenation, and cardiac output secondarily, particularly during single-lung ventilation, and also reflecting the balance of oxygen supply and demand in tissues. Given the lack of specificity, however, hemodynamic and gas measurements must be taken to diagnose the cause of any change in the supply/demand balance whenever there is a sudden drop in SvO2.

Anesthesia↗
PubMed1994

[The effect of the posture in the spread of the epidural anesthesia].

In 20 gynecological patients, the radionuclide was injected through the epidural catheter to determine the effect of the posture on the distribution of the radionuclide in the epidural space. Each 5 were placed on supine, right decubitus, left decubitus or sitting position and the posture was maintained for 30 min after the injection of the radionuclide. The distribution of the radionuclide in the epidural space was determined by measurement of gamma ray by a gamma camera. The data were stored and analyzed by a digital computer (SINTIPAC). In supine and right decubitus position, the radionuclide was distributed more on the right side and in the left decubitus position the radionuclide was distributed evenly. In the sitting position the radionuclide was distributed more caudad and the cephalad distribution was limited compared to the other postures. In summary the solution in the epidural space may move by the gravity but these effects were very slight and are of only minor clinical significance.

Adult↗
PubMed1998

[Comparison of gas exchange and hemodynamic variables during 2 types of exercise tests. Cycle-ergometry and the ergometric table].

The development of stress echocardiography on an ergometric table has increased the number of stress tests in the decubitus position, whereas most of the information currently available concerns stress tests in the sitting position or on the treadmill. In order to study the influence of this position of stress testing, the authors compared the results obtained in a series of 15 patients without cardiac disease (Group I) and another series of 15 coronary patients (Group II) undergoing the two types of stress testing, in the vertical position on a bicycle ergometer and in the lateral decubitus position on the ergometric table. Effort tolerance on the bicycle ergometer was significantly greater in terms of work load (202 +/- 35 vs 180 +/- 36 watts (p < 0.001) in the controls, and 120 +/- 32 vs 106 +/- 22 watts (p < 0.05) in the coronary group), of duration of effort (19 +/- 3 vs 16 +/- 3 minutes (p < 0.001) in the controls and 10 +/- 3 vs 8 +/- 2 minutes (p < 0.05) in the coronary patients), of heart rate (190 +/- 10 vs 172 +/- 21 beats/min (p < 0.005) in controls and 118 +/- 19 vs 111 +/- 14 beats/min (p < 0.05) in the coronary patients). On the other hand, blood pressure and O2 saturation tended to be greater during exercise in the decubitus position: SBP 200 +/- 23 vs 196 +/- 27 mmHg (NS) in the controls and 158 +/- 21 vs 166 +/- 23 mmHg (NS) in the coronary patients; DBP 97 +/- 10 vs 102 +/- 27 mmHg (NS) in the controls and 85 +/- 6 vs 90 +/- 10 mmHg (NS) in the coronary patients; O2 sat 96.8 +/- 1 vs 97.6 +/- 0.8% (p < 0.05) in the coronary patients. The anaerobic threshold and peak VO2 were much higher during exercise in the sitting position: oxygen consumption at the threshold 14.8 +/- 3.8 vs 12.6 +/- 2.3 ml.kg-1.min-1 (p < 0.01), peak VO2 22.2 +/- 5.9 vs 18.8 +/- 4.7 ml.kg-1.min-1 (p < 0.01) in the coronary patients. The results of this study show that the cardiovascular stimulation obtained in the decubitus position is not identical to that obtained by traditional exercise stress testing, particularly in coronary patients.

Adult↗
PubMed1987

Early diastolic time intervals during hypertensive pregnancy.

Early diastolic time intervals have been assessed by means of the echopolycardiographic method in 17 pregnant women who developed hypertension during pregnancy (HP) and in 14 normal pregnant women (N). Systolic time intervals (STI), stroke volume (SV), ejection fraction (EF), and mean velocity of myocardial fiber shortening (VCF) were also evaluated. Recordings were performed in the left lateral decubitus (LLD) and then in the supine decubitus (SD). In LLD, isovolumic relaxation period (IRP) was prolonged in the hypertensive pregnant women compared with normal pregnant women (HP 51 +/- 12.5 ms, N 32.4 +/- 15 ms p less than 0.05), whereas time of the mitral valve maximum opening (DE) was not different in the groups. There was no difference in SV, EF, and mean VCF, whereas STI showed only a significant (p less than 0.05) lengthening of pre-ejection period (PEP) in HP. When the subjects shifted from the left lateral to the supine decubitus position, left ventricular ejection time index (LVETi) and SV decreased significantly (p less than 0.05) in both normotensive hypertensive pregnant women. IRP and PEP lengthened significantly (p less than 0.05) only in normals, whereas they were unchanged in HP. DE time did not vary in either group. In conclusion, hypertension superimposed on pregnancy induces lengthening of IRP, as well as of PEP, and minimizes the effects of the postural changes in preload on the above-mentioned time intervals.

Adolescent↗
PubMed2004

Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: simultaneous recording of ambulatory electrocardiogram and posture.

BACKGROUND: Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self-protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA). HYPOTHESIS: Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF. METHODS: We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24-h ambulatory electrocardiogram monitoring before and after an 8-week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high-frequency (0.15 to 0.40 Hz) power (nHF) and the low-frequency (0.04 to 0.15 Hz)/high-frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively. RESULTS: When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 +/- 20 vs. 52 +/- 19 nu, p = 0.87; LF/HF, 1.39 +/- 1.11 vs. 1.32 +/- 1.32, p =0.93; L, nHF, 28 +/- 13 vs. 47 +/- 19 nu, p = 0.019; LF/HF, 3.34 +/- 2.48 vs. 1.56 +/- 1.39, p = 0.029; S, nHF, 38 +/- 17 vs. 53 +/- 16 nu, p = 0.0023; LF/HF, 2.43 +/- 2.21 vs. 1.03 +/- 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 +/- 30 vs. 18 +/- 24%, p = 0.0018; L, 11 +/- 20 vs. 27 +/- 26%, p = 0.025). CONCLUSIONS: In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears after the treatment.

Aged↗
PubMed2004

MRI of helium-3 gas in healthy lungs: posture related variations of alveolar size.

PURPOSE: To probe the variation of alveolar size in healthy lung tissue as a function of posture using diffusion-weighted helium-3 hyperpolarized gas imaging. MATERIALS AND METHODS: Measurements of the helium-3 apparent diffusion coefficient (ADC) were made on six healthy subjects. These were used to show the variation of alveolar size between the lowermost dependent regions of the lung compared to the uppermost regions of the lung in four postures: supine, prone, left-lateral decubitus, and right-lateral decubitus. RESULTS: The distribution of acinar size in the lungs was found to be heterogeneous, and influenced by lung orientation. In nearly all postures, the ADC was significantly higher in the non-dependent uppermost regions of the lung compared to the dependent lowermost regions of the lung; the greatest variation was found in the left-lateral decubitus position. The difference in ADC between uppermost and lowermost regions was on average 0.012 cm(2)second(-1), which represents 20% of the average ADC value for the whole lung. A systematic decrease in ADC from the apex of the lung to the base was also found, which corresponds to an inherent gradient in alveolar size. CONCLUSION: The posture dependent variations in ADC were attributed to compression of the parenchyma under its own weight and the mass of the heart.

Adult↗
PubMed1987

Bacteria isolated from skin and soft tissue lesions.

The pathogens most often isolated from lesions in skin and soft tissues were Staphylococcus aureus and Streptococcus pyogenes. Cultures from venous leg ulcers, decubitus ulcers and infectious gangrene often yielded also Pseudomonas spp., enterobacteria and enterococci. Obligate anaerobes were frequently isolated especially from abscesses and decubitus ulcers. One third of the abscesses and half of the decubitus ulcers yielded obligate anaerobes.

Abscess↗
PubMed2005

Use of a neck brace minimizes double-lumen tube displacement during patient positioning.

PURPOSE: When patients are moved from the supine to the lateral decubitus position, the double-lumen endobronchial tube (DLT) is often displaced. The aim of this study was to determine whether a DLT is displaced when there are no movements of the head and neck. METHODS: One hundred patients scheduled for elective thoracic surgery were randomly divided into control and brace groups. Only a left-sided DLT was used during the study. All patients in the brace group wore a neck collar before the positional change. Using a fibreoptic bronchoscope, the distance from the tracheal opening to the main carina and from the bronchial opening to the bronchial carina was measured in the supine and lateral decubitus positions. RESULTS: Displacement of the DLT (mean +/- SD) during a change from the supine to the lateral decubitus position was greater in the control group (6.3 +/- 5.5 mm in the trachea; 2.4 +/- 3.6 mm in the bronchus) than in the brace group (2.2 +/- 3.9 mm in the trachea; 0.6 +/- 3.1 mm in the bronchus); (P < 0.001). The incidence of clinically significant displacement, greater than 5 mm from the initial correct position, was higher in the control group than in the brace group (48% vs 12%, P < 0.001). CONCLUSION: By restricting head and neck movements with a neck brace, the DLT displacement could be minimized while positioning patients for thoracotomy. The main cause of the DLT displacement during lateral positioning appears to be related to movement of the head and neck.

Adult↗