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At least 145 records · Page 8Linked to original sources
PubMed2000

Oxygenation response to a recruitment maneuver during supine and prone positions in an oleic acid-induced lung injury model.

Prone position and recruitment maneuvers (RM) are proposed as adjuncts to mechanical ventilation to open up the lung and keep it open. We studied the oxygenation response to a RM (composed of a 30-s sustained inflation at 60 cm H(2)O airway pressure) performed in prone and supine positions in dogs after oleic acid- induced lung injury using an inspired O(2) fraction of 0.60. In one group (n = 6) first supine then prone positions were examined after a RM at 8 cm H(2)O and 15 cm H(2)O of positive end-expiratory pressure (PEEP). In the second group (n = 6) the sequence of positions was reversed. Prone positioning after supine position always improved oxygenation, whereas the decrement in Pa(O(2)) was relatively small when dogs were returned to the supine position. Oxygenation improved in both groups after a RM, and the improvement was sustained (after 15 min) in the prone position at 8 cm H(2)O of PEEP, but 15 cm H(2)O of PEEP was required in supine position. Our results suggest that a RM improves oxygenation more effectively with a decreased PEEP requirement for the preservation of the oxygenation response in prone compared with supine position.

Animals↗
PubMed2004

[The influence of the supine and prone positions in the esophageal pH monitoring in very low birth weight infants].

BACKGROUND: Scarce information is available on the effects of body's positioning in the number and the duration of gastroesophageal reflux episodes in very low birth weight infants. AIM: To evaluate the influence of prone compared to supine positions on the frequency and duration of acid gastroesophageal reflux episodes in very low birth weight infants and study the role of body position in the occurrence of exams with reflux index > or = 5% and > or = 10%. METHODS: Sixty one prolonged esophageal pH monitoring exams were retrospectively analyzed. The difference between the prone and supine position exam duration was not longer than 3 hours. The reflux index was evaluated for the total period of the exam (reflux index total) and for each period in the two positions. The total number of reflux episodes, the number of reflux episodes > 5 minutes and the longest reflux episode were evaluated for each period in the two positions. These parameters were compared in accordance with body positioning, for each one of the three reflux index total categories: reflux index total < 5%, > or = 5% and > or = 10%. The frequencies of exams with reflux index total > or = 5% and reflux index total > or = 10% were compared for both positions. RESULTS: The number of hours in prone (11.2 +/- 1.0) and in supine (11.2 +/- 1.1) position were not different. All the prone positions monitoring parameters were significantly lower than the supine ones, in the three reflux index total categories. In the supine position, 32.7% (20/61) and 27.8% (17/61) of the exams, which were normal in prone, became abnormal, taking into account reflux index > or = 5% and > or = 10%, respectively, obtained for each position. CONCLUSIONS: In prone position, there is a significant decrease in number and duration of acid reflux episodes in very low birth weight infants. Supine position promotes a significant increase in the number of esophageal pH monitoring exams with reflux index > or = 5% and > or = 10%, making easier the diagnose of the gastroesophageal reflux disease.

Esophagus↗
PubMedDate not supplied

Position of the subtalar joint axis and resistance of the rearfoot to supination.

Determination of the position of the subtalar joint axis is being more widely used clinically to facilitate the prescription of foot orthoses and the understanding of foot function, but clinical determination of the axis has not been widely investigated. The aim of this study was to determine the relationship between clinical determination of the subtalar joint axis and the amount of force needed to supinate the foot. The transverse plane position of the subtalar joint axis was determined in 47 subjects. The sagittal plane orientation of the subtalar joint axis was determined using the relative amounts of forefoot adduction and abduction obtained when the rearfoot was supinated and pronated. The amount of force needed to supinate the foot was measured using a device designed to measure resistance to supination. The only two parameters that were correlated to supination resistance of the rearfoot were body weight (r = 0.52) and the perpendicular distance from the fifth metatarsal head to the subtalar joint axis (r = 0.59). The model on which determination of the subtalar joint axis is based may not be valid, but it might help determine how much force is needed to supinate a foot using foot orthoses.

Adult↗
PubMed1992

[Aggravation of hypoxemia in supine position in myotonic dystrophy].

Myotonic dystrophy (MyD) involves a variety of systems. Respiratory disorders are common, namely elevation of diaphragm, alveolar hypoventilation, aspiration pneumonia and sleep apnea. We evaluated respiratory involvement. The subjects were 11 patients with MyD. Also 6 patients with limb girdle muscular dystrophy (LG) were examined to be compared with MyD. Both groups had the similar activities of daily living. All of them never complained of dyspnea. Arterial blood gas studies were performed in supine position and standing position. A new evidence was found that hypoxemia was aggravated and alveolar-arterial oxygen pressure difference was increased in supine position in MyD. Next, pulmonary function tests were done in supine position and sitting position. Functional residual capacity (FRC) were more reduced in supine position in MyD compared with LG. The value to subtract closing capacity from FRC was negative in supine position in MyD, showing closing phenomenon. We propose the mechanism of the aggravation of hypoxemia may be the following. The reduction of FRC caused by respiratory muscle involvement brings out the closing phenomenon. Abnormal uneven distribution of ventilation-perfusion ratio happens and then hypoxemia is worsened in supine position in MyD.

Adult↗
PubMed2004

Prone versus supine patient positioning during gated 99mTc-sestamibi SPECT: effect on left ventricular volumes, ejection fraction, and heart rate.

UNLABELLED: Gated myocardial perfusion SPECT allows assessment of left ventricular end-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular stroke volume (SV), and left ventricular ejection fraction (LVEF). Acquiring images with the patient both prone and supine is an approved method of identifying and reducing artifacts. Yet prone positioning alters physiologic conditions. This study investigated how prone versus supine patient positioning during gated SPECT affects EDV, ESV, SV, LVEF, and heart rate. METHODS: Forty-eight patients scheduled for routine myocardial perfusion imaging were examined with gated (99m)Tc-sestamibi SPECT (at rest) while positioned prone and supine (consecutively, in random order). All parameters for both acquisitions were calculated using the commercially available QGS algorithm. RESULTS: Whereas EDV and SV were significantly lower (P < 0.0004) for prone acquisitions (EDV, 110.5 +/- 39.1 mL; SV, 55.9 +/- 13.3 mL) than for supine acquisitions (EDV, 116.9 +/- 36.2 mL; SV, 61.0 +/- 14.5 mL), ESV and LVEF did not differ significantly. Heart rate was significantly higher (P < 0.0001) during prone acquisitions (69.1 +/- 10.5 min(-1)) than during supine acquisitions (66.5 +/- 10.0 min(-1)). CONCLUSION: The observed position-dependent effect on EDV, SV, and heart rate might be explained by decreased arterial filling and increased sympathetic nerve activity. Hence, supine reference data should not be used to classify the results of prone acquisitions.

Adult↗
PubMed1989

[Potentiating effect of a supine position on ischemia induced by exercise].

Though sitting bicycle and treadmill are the commonest devices used in exercise stress testing, supine ergometric test shows some advantages, especially in research investigations. The latter allows better ECG and blood pressure recordings during exercise. Recently, a greater frequency of ST-segment depression has been reported with supine vs upright exercise, but some doubt as to the ischemic significance of this result has been raised. Thus, we compare the ECG and hemodynamic pattern during upright and supine bicycle exercise in 50 subjects with chest pain, without prior myocardial infarction: 31 had documented coronary artery disease (CAD) and 19 had normal coronary vessels. In a subgroup (22 CAD patients and all subjects without CAD) a measurement of myocardial perfusion was performed during exercise using thallium-201 radionuclide ventriculography. Initial work-load and the further graded increases were identical for both postures. The frequency of ST-segment depression was higher during supine exercise (84% vs 74%). The increase in sensitivity (+7% vs CAD) was wider if a more direct measurement of myocardial ischemia was adopted as gold standard (+13% vs TI-201 responses) and was not associated with a decreased specificity (Tab. II). In the supine position the threshold of exercise-induced ST-segment depression was significantly lower. Chest pain appeared more frequently and at a lower work-load. Accentuation and precocity of exercise-induced ischemia in the supine-position could be attributed to an increased imbalance between supply and demand of MVO2 at equivalent work-load, heart rate changes, systolic blood pressure and double product were significantly higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Echocardiographic determination of valid zero reference levels in supine and lateral positions.

BACKGROUND: The phlebostatic axis--the junction of the fourth intercostal space and the midpoint of the anterior-posterior diameter--has been accepted as a reliable external reference point for the mid-right and mid-left atrium. Acceptance of this reference point is based upon research conducted in 1945 that measured venous pressures in the hands of subjects positioned with the head of the bed raised to different levels. The validity of this reference point for intracardiac pressure measurements in supine or laterally positioned patients has not been established. PURPOSE: To determine the validity of the phlebostatic axis in the supine and lateral positions. METHODS: To determine validity in the supine position, we compared the distance from the phlebostatic axis to a fixed external point (the bed surface) and the distance from the right and left atria in the supine position to this same fixed external point. The distances from the right and left atria to the bed surface were determined with echocardiography and were used as the standard for the proper position of external reference points. To determine the validity of the phlebostatic axis in lateral positions, we compared the distances from the right atrium and left atrium to the bed surface in the supine position with those distances in different lateral positions. RESULTS: We analyzed the data of 25 normal, healthy subjects. The study findings show that the phlebostatic axis is a valid reference point for the right atrium, and the phlebostatic axis and midanterior-posterior diameter are valid reference points for the left atrium in the supine position. However, neither is a valid external reference point in the lateral positions. Pressure measurements obtained when patients are in the lateral positions are not accurate. There remains a need to develop valid methods of accurate pressure measurements in various body positions.

Adult↗
PubMed1995

Comparisons of pulmonary artery pressure measurements in supine and 30 degree lateral positions.

The purpose of this study was to compare the effects on pulmonary artery pressure (PAP) measurements of using different anatomical reference points for transducer placement. Supine and 30 degree right and left lateral PAP measurements were examined in a sample of 40 hemodynamically stable post-cardiovascular surgery patients. The anatomical references for transducer placement were (a) the supine phlebostatic axis, (b) the right lateral phlebostatic axis, and (c) the mid-sternum at the fourth intercostal space. The results of analysis of variance procedures for repeated measures showed lateral compared to supine PAP measurements differed significantly regardless of the anatomical reference used for the transducer placement (p = < .0001). Clinically insignificant differences in supine and lateral PAP measurements were shown when the transducer reference was the supine phlebostatic axis. Use of the right lateral phlebostatic axis and the mid-sternum did result in clinically significant changes in lateral compared to supine PAP measurements. Implications for research and for clinical practice are discussed.

Adult↗
PubMed1997

Technetium-99m-MIBI myocardial SPECT: supine versus right lateral imaging and comparison with coronary arteriography.

UNLABELLED: Myocardial perfusion SPECT using the prone position improves inferior wall counts and decreases motion problems as compared with the usual supine position. Nonetheless, it is not suitable for women. In addition, it is associated with artifactual anteroseptal defects and hot spots. METHODS: The right lateral (RL) position was evaluated instead of the prone position in 72 patients (26 women). RL imaging was performed immediately after the supine imaging during a routine 2-day 99mTc-sestamibi exercise protocol. The SPECT images were scored semiquantitatively by three physicians. Moreover, regional myocardial counts, as well as extent and severity of defects, were assessed by quantitative polar map analysis. RESULTS: All patients tolerated the RL position well and there was no significant patient movement in either position. Higher inferior myocardial counts per pixel were observed in the RL than in supine images. Inferior wall defects (especially mild ones) were more common in the supine than the RL images, whereas defects in other regions were not different. Quantitative analysis confirmed these findings. Analysis of 34 patients with recent coronary arteriography revealed an overall coronary artery disease (CAD) supine- and RL-imaging specificity of 50% and 75%, respectively, and the sensitivities of both were 93%. Right CAD sensitivity, specificity and normalcy rates for the supine position were 100%, 44% and 55%, whereas those of the RL position were 94%, 75% and 90%, respectively. CONCLUSION: The RL position improves CAD diagnostic accuracy, particularly right CAD, without significant artifacts in other myocardial regions. Unlike the prone position, the RL position is well tolerated by both women and men.

Artifacts↗
PubMed1990

Comparison of effects of upright versus supine body position and liquid versus solid bolus on esophageal pressures in normal humans.

New studies monitoring ambulatory esophageal pressures during food ingestion often compare results to normal values obtained from supine liquid swallows. We compared distal esophageal peristaltic and lower esophageal sphincter (LES) pressures in 15 normal subjects during six liquid swallows in the upright and supine positions, and six solid (small marshmallow) swallows in upright position. LES pressures were significantly (P less than 0.05) higher supine than upright but no differences were noted in LES pressure, relaxation, and duration of relaxation between upright solid and liquid swallows. Distal peristaltic wave velocities were faster upright than supine. Peristaltic wave amplitudes, durations, and DP/DT were significantly (P less than 0.05) greater in supine than in upright position. Atypical wave forms, defined as nontransmitted, simultaneous, and simultaneous/repetitive, increased in the upright position compared to supine (P less than 0.01), and during solid vs liquid swallows (P less than 0.05). These results indicate that body position substantially affects normal distal esophageal peristalsis and LES pressure and that "abnormal" wave forms occur more frequently during swallowing solids than liquids in the upright position. Conclusions regarding "abnormal" motility over prolonged periods and during food ingestion in patients should be tempered by these findings.

Adult↗
PubMed1981

[Plasma catecholamines, metabolic substrates, aerobic and anaerobic capacity during exercise in supine and sitting position (author's transl)].

The influence of a graduated bicycle ergometric test in supine and sitting position on the work capacity, the plasma catecholamines, the carbohydrate (glucose and lactate) and lipid metabolism (free fatty acids and glycerol) and the heart rate and oxygen intake was examined in six healthy subjects. The work capacity is approx. 30% higher in sitting position. In supine position, adrenaline and nor-adrenaline are lower at rest, at all submaximum levels and during maximum ergometric exercise. Glucose, free fatty acids and glycerol show no differences dependent on the body position at the same submaximum levels, only the lactate level is approx. 30% higher (200 Watt) in supine position. During maximum graduated exercise in sitting position the glucose level is 10% higher than in supine position, the free fatty acids show no difference; the lactate level is approx. 37% higher, the glycerol level approx. 40% than in supine position. The heart rate and the oxygen intake don't show any position dependent differences at rest and at the same submaximum levels. During maximum ergometric exercise they are 15% (heart rate) and about 30% (oxygen intake) higher than in supine position, corresponding to a higher exercise level.

Adult↗
PubMed1988

Comparison of ST segment depression in upright treadmill and supine bicycle exercise testing.

Significant differences in the hemodynamic response to upright and supine exercise have been reported in patients with coronary artery disease. The purpose of the present study was to compare the degree of myocardial ischemia as assessed by ST segment depression during upright treadmill and supine bicycle exercise in 98 patients with coronary artery disease and in 34 patients with normal coronary arteries. The amount of ST segment depression at maximal exercise in patients with coronary artery disease was 0.90 +/- 0.80 mm for treadmill and 1.34 +/- 1.09 mm for supine bicycle (p less than 0.001). The amount of ST segment depression during treadmill and supine bicycle exercise tests was also compared at highest similar heart rates (0.68 +/- 0.77 versus 1.17 +/- 1.01, p less than 0.001), at highest similar rate-pressure products (0.71 +/- 0.77 versus 1.08 +/- 1.04, p less than 0.001), at highest similar metabolic equivalents of oxygen consumption (MET) levels (0.69 +/- 0.75 versus 1.20 +/- 1.05 mm, p less than 0.001) and at the onset of angina (0.84 +/- 0.73 versus 1.18 +/- 0.88 mm, p less than 0.001). The rate-pressure product achieved at maximal exercise was similar in both tests (18.74 +/- 5.80 x 10(3) versus 18.81 +/- 5.17 x 10(3), p = NS). The occurrence of angina during treadmill and supine bicycle exercise tests was similar (47 of 98 versus 48 of 98, respectively, p = NS). For the detection of coronary artery disease, the sensitivity was 50.0% for treadmill and 63.3% for supine bicycle (p less than 0.05) and the specificity was 73.5 versus 70.6%, respectively (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Left ventricular ejection fraction during supine and upright exercise in patients with systemic hypertension and its relation to peak filling rate.

In hypertensive patients with hypertrophy, abnormal peak filling rate (PFR) is related to a decline in left ventricular (LV) ejection fraction (EF) during supine exercise. Because an increased LV preload is more common during upright exercise, we determined this relation during upright and supine exercise. In 20 hypertensive patients, rest and exercise radionuclide angiography in the supine and upright positions, as well as echocardiography, were performed and compared with 20 age-matched controls. At rest in the supine and upright positions, blood pressure, LVEF, and PFR were 164 +/- 20/94 +/- 10 and 164 +/- 24/94 +/- 10 mm Hg, 65 +/- 8% and 65 +/- 6%, and 2.77 +/- 0.59 and 2.70 +/- 0.52 end-diastolic volumes/s, respectively. PFR was reduced compared with controls (3.29 +/- 0.3 and 3.27 +/- 0.27 end-diastolic volumes/s, supine and upright). LV mass index was normal (94 +/- 19 g/m2). LVEF increased during upright but not during supine exercise in the hypertensives. Four patients had a decline in each position versus none of the controls. There was no relation between the change in LVEF and rest PFR. In patients with mild to moderate hypertension without extensive hypertrophy, abnormal filling rates were present but did not correlate with the change in LVEF with exercise.

Coronary Angiography↗
PubMed1993

Technique and use of supine oblique views in acute cervical spine trauma.

STUDY OBJECTIVE: To determine whether the addition of the supine oblique view of the cervical spine can detect fractures or ligamentous injury not seen on the standard three-view examination. DESIGN: Radiographs of patients with documented cervical spine injury were reviewed retrospectively by three neuroradiologists. Patients were included in the study if the initial interpretation of the three-view series was normal and the abnormal supine oblique view enabled a correct diagnosis to be established. SETTING: The emergency department of a university-affiliated hospital with Level I trauma center status. TYPE OF PARTICIPANTS: Eighty-three consecutive patients with documented cervical spine injury evaluated during a 20-month period. RESULTS: Eight patients demonstrated abnormality to best advantage on the supine oblique view. These included six fractures and two ligamentous injuries. Five patients had abnormalities confined to the supine oblique view, and the remaining three had subtle abnormalities on the cross-table lateral view. CONCLUSION: The supine oblique view may detect fractures or ligamentous injury not identifiable on the standard three-view examination. We recommend the routine use of a five-view cervical spine series with the inclusion of 30-degree supine oblique views in the evaluation of acute cervical spine injury.

Cervical Vertebrae↗
PubMed2002

Three-dimensional intrafractional movement of prostate measured during real-time tumor-tracking radiotherapy in supine and prone treatment positions.

PURPOSE: To quantify three-dimensional (3D) movement of the prostate gland with the patient in the supine and prone positions and to analyze the movement frequency for each treatment position. METHODS AND MATERIALS: The real-time tumor-tracking radiotherapy (RTRT) system was developed to identify the 3D position of a 2-mm gold marker implanted in the prostate 30 times/s using two sets of fluoroscopic images. The linear accelerator was triggered to irradiate the tumor only when the gold marker was located within the region of the planned coordinates relative to the isocenter. Ten patients with prostate cancer treated with RTRT were the subjects of this study. The coordinates of the gold marker were recorded every 0.033 s during RTRT in the supine treatment position for 2 min. The patient was then moved to the prone position, and the marker was tracked for 2 min to acquire data regarding movement in this position. Measurements were taken 5 times for each patient (once a week); a total of 50 sets for the 10 patients was analyzed. The raw data from the RTRT system were filtered to reduce system noise, and the amplitude of movement was then calculated. The discrete Fourier transform of the unfiltered data was performed for the frequency analysis of prostate movement. RESULTS: No apparent difference in movement was found among individuals. The amplitude of 3D movement was 0.1-2.7 mm in the supine and 0.4-24 mm in the prone positions. The amplitude in the supine position was statistically smaller in all directions than that in the prone position (p < 0.0001). The amplitude in the craniocaudal and AP directions was larger than in the left-right direction in the prone position (p < 0.0001). No characteristic movement frequency was detected in the supine position. The respiratory frequency was detected for all patients regarding movement in the craniocaudal and AP directions in the prone position. The results of the frequency analysis suggest that prostate movement is affected by the respiratory cycle and is influenced by bowel movement in the prone position. CONCLUSION: The results of this study have confirmed that internal organ motion is less frequent in the supine position than in the prone position in the treatment of prostate cancer. RTRT would be useful in reducing uncertainty due to the effects of the respiratory cycle, especially in the prone position.

Fluoroscopy↗
PubMed2001

Effect of lateral versus supine wedged position on development of spinal blockade and hypotension.

Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. They were then given spinal anaesthesia in the left lateral position and randomised to be turned to the right lateral or the supine wedged position, after which speed of onset and spread of blockade to cold sensation were measured every 2 min for 10 min and mean arterial pressure and ephedrine requirement were recorded every minute for 20 min. Baseline mean arterial pressure was 9 mmHg (95% CI 3 to 14) lower in the left lateral (measured in the upper arm) than in the sitting position; those in the supine wedged and tilted positions were intermediate. Following spinal anaesthesia, hypotension (defined as a reading </=80% of the baseline value in the same position) lasted 2.4 min longer (CI +0.6 to +4.1) in the supine wedged group, but there was no significant difference between the groups in maximum fall or ephedrine requirement. The upper level of block rose more rapidly in the supine wedged than in the lateral group and showed less variability. There is therefore no reason to fear the unmodified lateral group position, which may offer better protection against hypotension.

Clinical Trial↗
PubMed1994

Supine and upright radionuclide esophageal transit before and after treatment for achalasia.

The authors hypothesized that radionuclide esophageal transit (RET) studies performed in the upright position and aided by gravity would provide better objective evaluation of achalasia than supine scanning and would correlate better with the degree of symptomatic relief after treatment. Radionuclide esophageal transit studies were prospectively performed in both the supine and upright positions in four symptomatic patients before treatment, after simple dilation, and after pneumatic dilation in patients who did not respond to simple dilation. After simple dilation, two patients reported near resolution of symptoms. Supine RET revealed little improvement, but upright esophageal emptying was markedly improved at 2, 5, and 10 minutes. In the two patients who had no relief after simple dilation. RET failed to show improvement while they were in either the supine or the upright position. These patients subsequently underwent pneumatic dilation that resulted in resolution of symptoms and marked improvement in upright RET only. In the supine position, the esophageal emptying at 2 minutes in the four patients after successful dilation improved from 0% baseline to a mean of 14% (+/- 18%). However, in the upright position, esophageal emptying improved from 3% (+/- 3%) to 73% (+/- 17%) and better correlated with symptomatic relief. The difference in improvement in esophageal emptying in the upright versus the supine position was statistically significant (P = 0.0033). The authors conclude that only upright esophageal emptying provides objective evidence that correlates well with symptomatic relief.(ABSTRACT TRUNCATED AT 250 WORDS)

Dilatation↗
PubMed1985

Standing and supine Cobb measures in girls with idiopathic scoliosis.

The standing Cobb measure in a group of 287 girls with idiopathic scoliosis at the start of treatment was in the mean approximately 9 degrees larger than the supine Cobb measure. This mean standing-supine difference was essentially independent of curve severity expressed by the supine Cobb measure. Because of this, when the difference was expressed as a percentage of the supine Cobb measure, the mean values of this ratio decreased substantially with increasing curve severity. The mean difference decreased only slightly with age through adolescence, indicating that spine lateral curves stiffen little as patients mature. The standard deviations in the standing minus supine Cobb differences were approximately 6 degrees in the majority of the age and severity groupings studied. Ninety-three percent of these patients had standing-supine Cobb measure differences that were between 0 degrees and 20 degrees.

Adolescent↗