Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DECUBITUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,567 records · Page 87Linked to original sources
PubMed1998

Comparison of supine and lateral positioning on various clinically used support surfaces.

In this study, interface pressures, transcutaneous oxygen tension (TcPO2), and blood flow were compared with the classic pressure ulcer-prone areas in the supine and lateral position on six different high- and low-air-loss support surfaces. Interface pressures were substantially higher in the lateral decubitus than in the supine position. Consistent with this, mean TcPO2 and blood flow readings over the trochanter in the lateral position were lower than over the sacrum and ischium in the supine position. With weighting, the average TcPO2 readings decreased from 78.6 mmHg to 11.9 mmHg on the trochanter and from 65.4 mmHg to 45.7 mmHg on the sacrum and ischium. In parallel, average laser Doppler readings decreased from 2.3 to 0.7 laser Doppler flow units over the trochanter, but did not change significantly over the sacrum and ischium. These data support the clinical suggestion that the lateral decubitus position should not be maintained for long periods of time, not even on many special support surfaces.

Adult↗
PubMed1988

Scintigraphic assessment of the anorectal angle in health and after ileal pouch-anal anastomosis.

To determine whether the anorectal angle was preserved after ileal pouch-anal anastomosis, a simple, safe, low-radiation, real-time method of imaging the anorectum was developed. A cylindrical balloon was placed in the neorectum and anal canal and filled with a solution of 99mTc in water. A gamma camera then imaged the angulation of the balloon while the subject was at rest, during sphincteric squeeze, and during a Valsalva maneuver. Thirteen healthy volunteers and six patients were studied after ileal pouch-anal anastomosis. An angle was identified in all controls and patients. In the lateral decubitus position at rest, the mean anorectal angle in controls (102 +/- 18 degrees; SD) and anopouch angle in patients (108 +/- 19 degrees) were similar (p = 0.3). Sitting straightened the angle in both groups (p less than 0.03), whereas sphincteric squeeze and a Valsalva maneuver sharpened the angle in both the sitting and standing positions (p less than 0.03). In the lateral decubitus position, however, the pouch group was less able to sharpen the angle than were the controls (p = 0.04). In controls, the anorectal junction descended during sitting and elevated during squeeze (p less than 0.03), but this did not occur in the pouch group. In conclusion, maneuvers favoring or stressing continence (squeeze, Valsalva) sharpened the anorectal angle and elevated the pelvic floor, whereas a maneuver favoring defecation (sitting) straightened the angle and caused the pelvic floor to descend. After ileal-anal anastomosis, the angle and its movements (except those while lying) were similar to controls. Elevation of the pelvic floor during squeeze, however, was decreased, indicating a decreased mobility of the pelvic floor after operation.

Adult↗
PubMed1989

The use of a tissue expander to enlarge a graft for surgical treatment of a pressure ulcer in a quadriplegic. Case report.

This case reports the use of a tissue expander to facilitate the surgical closure of a decubitus ulcer in a spinal cord injured quadriplegic. The patient is a 42-year-old man with chronic nonhealing of a right ischial pressure ulcer. It had required a flap rotation and partial ischiectomy in the remote past that had been problem-free for many years. The patient subsequently required the placement of a new flap, but insufficient tissue was available to close the wound with the hip in 90 degrees of flexion. Closing the wound with the hip in extension merely led to breakdown when the hip was put in the 90 degrees of flexion required for the sitting position. The problem was solved by using a tissue expander to increase the available soft tissue. A tissue expander was inserted and gradually expanded over a period of weeks by injecting it with fluid. It was then removed, and the expanded tissue that had grown over it allowed closure of the wound without tension on the tissues with the hip in flexion. The patient subsequently returned to the sitting position and his work as a computer programmer. Tissue expanders are commonly used in breast reconstruction, but have found many other uses in plastic surgery over the last decade. It is felt that tissue expansion techniques should not be the primary surgery treatment of decubitus ulcers, but can be used in difficult cases like this one to provide additional tissue.

Adult↗
PubMed2001

Simultaneous anterior-posterior thoracolumbar spine surgery.

The purpose of this article is to report our experience with simultaneous anterior and posterior approach spine surgery. The patient is placed in the decubitus position. Two teams of spine surgeons simultaneously perform surgical approaches, decompression, arthrodesis, and instrumentation. No repositioning, repreparing, or redraping is necessary. Twelve patients with varying lesions underwent this procedure. This technique is presented as an alternative to the sequential single-staged anterior and posterior procedure and the two-staged procedures performed under separate anesthetics. Although no statistical significance can be concluded, we believe a larger series will demonstrate that operative time is decreased, potential risks of repositioning are avoided, and superior exposure and mobilization of spinal elements are afforded. Exposure, decompression, and stabilization posteriorly is feasible in the decubitus position.

Adolescent↗
PubMed1991

Inaccuracies in quantitative radionuclide renal imaging due to patient position or diverging collimation.

Radionuclide renal studies with quantitative measurements in patients confined to intensive care units usually require the use of a 10-inch field-of-view mobile gamma camera and a diverging collimator to image both kidneys simultaneously. The patient must frequently be in the lateral decubitus position so imaging can be performed in the posterior projection. Due to spatial distortion caused by the diverging collimator, variations in detector angulation and kidney depth produce different detection efficiencies for each kidney. Counts in regions of interest over the kidneys were compared as a function of detector angulation and patient position (prone and lateral decubitus). Substantial variations were observed comparing the diverging collimator data to 15-inch field-of view parallel hole acquisitions. Significant variation can also be obtained with parallel hole collimators when the patient's position is changed.

Gamma Cameras↗
PubMed1997

Insights into the increased oxygen demand during chest physiotherapy.

OBJECTIVES: To determine the mechanism responsible for the increase in oxygen consumption (VO2) during chest physical therapy. Specifically, to examine the hypothesis that muscular activity is the major contributor to the increase in oxygen demand. DESIGN: Prospective, observational study. SETTING: University hospital surgical intensive care unit. PATIENTS: Phase one included 13 patients who were mechanically ventilated after coronary artery bypass surgery. Phase two involved seven mechanically ventilated patients who had undergone major vascular or abdominal surgery. INTERVENTIONS: Phase one involved turning patients to the lateral decubitus position. During the second phase, patients were given midazolam (0.15 microg/kg) 2 mins before an initial chest physiotherapy session and midazolam plus vecuronium (0.7 mg/kg) before a subsequent session. Physiologic measurements were made during the resting periods before and following each session, as well as at the completion of the intervention. MEASUREMENTS AND MAIN RESULTS: Turning patients to the lateral position resulted in significant increases in oxygen uptake and CO2 elimination (VCO2). VO2 increased from 219 +/- 21 (SD) mL/min at rest to 324 +/- 58 mL/min (p <.05) with turning. These increases in oxygen demand were met by increases in both oxygen delivery (852 +/- 238 mL/min at rest to 1116 +/- 430 mL/min, p < .05) and extraction (0.27 +/- 0.7 at rest to 0.32 +/- 0.09, p < .05). There were associated increases in hemodynamic and respiratory variables including heart rate and systolic blood pressure. The administration of vecuronium completely suppressed the 50% increases in VO2 and VCO2 seen without the use of a muscle relaxant. The increases in systolic blood pressure were unaffected by vecuronium. The magnitude of the increase in PaCO2 (32 +/- 5 torr [4.3 +/- 0.7 kPa] at rest to 36 +/- 5 torr [4.8 +/- 0.7 kPa] during therapy, p < .05), was not accentuated by vecuronium (30 +/- 4 torr [4.0 +/- 0.5 kPa] to 35 +/- 6 torr [4.7 +/- 0.8 kPa], p < .05) despite a lack of any increase in minute ventilation or respiratory rate. This change was due to the parallel suppression of VCO2. CONCLUSIONS: The increase in metabolic demand during chest physiotherapy is the result of increased muscular activity as evidenced by the suppression of VO2 following the administration of the muscle relaxant and the observation that turning a patient into the lateral decubitus position produces similar increases in VO2. The increases in blood pressure and cardiac output are due to another mechanism, most likely enhanced sympathetic output. The increase in physiologic activity produced by chest physiotherapy is thus secondary to both exercise-like and stress-like responses.

Aged↗
PubMedDate not supplied

Complications of osteotomies in severe cerebral palsy.

Seventy-nine consecutive children with cerebral palsy who underwent osteotomies about the hip for subluxation or dislocation were studied retrospectively to determine risk factors that would correlate with postoperative complications of death, fracture, or decubitus ulcer. Except for the three patients who died, all of the children had > or = 1 year of follow-up. Twenty (25%) patients had at least one complication. Three children died; one at 1 week, one at 2 weeks, and one at 5 months after surgery. Sixteen patients sustained 25 fractures. All were managed with cast or splint immobilization in the clinic. Five patients developed decubitus ulcers requiring > or = 2 weeks of local care, but none required skin grafts or flaps. Complications occurred in 13 (68%) of 19 children with gastrostomies or tracheostomies but in only seven (12%) of the remaining 60 children. Only one (8%) of 13 ambulatory patients had a complication compared with 19 (29%) of 66 nonambulatory patients. In conclusion, ambulatory function correlates well with the risk of complications after osteotomies. A nonambulatory patient with a gastrostomy or tracheostomy is at even greater risk. Fortunately the fractures and ulcers observed in this series healed uneventfully with no operative intervention.

Adolescent↗
PubMedDate not supplied

Osteomyelitis of the pelvis/hips in paralyzed patients: accuracy and clinical utility of MRI.

PURPOSE: The goal of our study was to determine the accuracy and clinical utility of MRI in the diagnosis of osteomyelitis of the pelvis/hips in paralyzed patients. METHOD: In 44 paralyzed patients, 59 consecutive MR examinations of the pelvis/hips were evaluated prospectively. Criteria for diagnosis of osteomyelitis were based on those established in previous studies of complex, nonhematogenous osteomyelitis (diabetic foot). Average follow-up was 3 years. The standard of reference for the diagnosis of osteomyelitis was histologic/microbiologic results of surgical biopsy specimens or clinical follow-up. Note was made if decubitus ulcers, sinus tract, fistula, fluid collection, abscess, septic arthritis, joint effusion, bursitis, or heterotopic ossification was present on MRI. Comparison of the extent of infection by MRI and surgical margins was performed. Effect on surgical treatment was defined by absence of recurrent infection at the surgical site within 6 weeks of limited resection. RESULTS: The criteria for diagnosis of osteomyelitis were fulfilled in 49 of 57 MR studies for an overall accuracy of 97%. There was one false-negative MR study. MRI for the diagnosis of osteomyelitis yielded a sensitivity of 98% and a specificity of 89%. There were 41 decubitus ulcers, 28 sinus tracts, 2 fistulae, 14 fluid collections, 15 abscesses, 9 hips with septic arthritis, 10 "bland" hip effusions, 5 cases of trochanteric bursitis, and 30 patients with heterotopic ossification. Twenty-one patients underwent limited surgical resection guided by MR findings in which only the enhancing area was resected. There was only one recurrence of osteomyelitis at the surgical margins. CONCLUSION: MRI is accurate in the diagnosis of osteomyelitis and associated soft tissue abnormalities in spinal cord-injured patients. MRI can delineate the extent of infection in guiding limited surgical resection and preserving viable tissue.

Abscess↗
PubMed2006

Postprandial stomach contents have multiple acid layers.

GOALS: The purpose of this study was to evaluate patterns in gastric pH both fasting and postprandially in different body positions. STUDY: Ten healthy volunteers were studied. A pH probe was positioned with an electrode 15 cm below the lower esophageal sphincter proximal border then withdrawn 1 cm every 30 seconds to 5 cm above the lower esophageal sphincter. Volunteers were tested on 2 occasions. Initially, they were studied in a semirecumbent position (45 degrees), with the first pull-through after 6 hour fasting. After a meal, a pull-through was repeated 4 consecutive times (approximately 15, 30, 45, and 60 min). On a subsequent day, the positions were changed with each pull-through: upright, supine, right decubitus, and left decubitus. The order of these positions was randomly selected. RESULTS: The pH step-up is defined as a change in pH from a gastric to an esophageal pH (<4-->>4). No significant difference was found between location of the pH step-up in the fasting and postprandial pull-throughs. An area of lower pH was consistently found within 2 cm distal to the step-up area. Distal to the area of higher gastric pH (median pH at 5), a second acid layer was found. This pattern persisted through the 4 postprandial pull-throughs, irrespective of body position. CONCLUSIONS: The pH step-up was persistent in the fasting period and for 1 hour postprandially, but did not migrate proximally. Gastric buffering from a meal creates a nonuniform environment with at least 2 acid layers. This pattern is present irrespective of body position. The lack of homogeneity of stomach content postprandially helps to explain the observation of occasional persistent acid gastroesophageal reflux after a meal.

Adult↗
PubMed2006

Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue.

BACKGROUND: Numerous studies have examined cross-sectional data to determine the relationships between nurse staffing and patient outcomes. Questions have been raised about some of the studies now in the literature regarding the use of the hospital as the unit of analysis and the cross-sectional design of the studies. Additionally, there is a concern that the primary outcomes being studied are negative. OBJECTIVE: Objectives of this study are to (1) compare the relationships between nurse staffing and positive patient outcomes for 3 adult medical-surgical nursing units in one university teaching hospital across 4 years (16 fiscal quarters); and (2) explore the use of 2 new failure-to-rescue (FTR) rates as outcomes, specifically FTR from medication errors and FTR from decubitus ulcers. DESIGN: This study uses secondary analyses of data viewed retrospectively with a longitudinal repeated-measures design to estimate the relationships between nurse staffing and the outcomes of interest. RESULTS: Accounting for total dollars and case mix, all patient satisfaction measures increased as total hours of care per patient day increased, and as the skill mix became richer (more RN hours/total hours) there was a higher satisfaction with pain management and physical care requests. There was an increase in FTR from medication error as the non-RN (Other) hours of care per patient day increased and there was an increase in FTR from decubitus ulcers as patient severity increased. CONCLUSION: The overall conclusion is that it will likely be necessary to vary staffing hours and staffing mix depending on which positive patient outcome or outcomes you wish to achieve.

Adult↗
PubMed2000

Rotational alignment of humerus after closed locked nailing.

OBJECTIVE: Rotational malalignment that may happen during closed nailing of humeral fractures is, to date, an unexplored area of investigation. The purpose of this study was to examine the effect of arm position during surgery on humeral rotational alignment and the effect of this alignment on shoulder motion and function. METHODS: Thirty patients with eventual fracture healing after closed humeral locked nailing were retrospectively studied: 15 had retrograde nailing; 15, antegrade. Retrograde nailing was performed with the patient in a decubitus position and with the upper arm anteriorly flexed and the forearm perpendicular to the operating table. Antegrade nailing was performed with the patient in a semisitting position and with the upper arm in the so-called resting position. The humeral retroversion angle as measured by computed tomographic scan, range of shoulder rotation, and Neer score of the shoulder for the fractured and the intact humeri were determined, and the discrepancy (i.e., value for the intact subtracted from that for the fractured) between the two was noted. To test the effect on alignment of positioning during retrograde nailing, we similarly determined retroversion angles for another 15 patients treated in a supine resting position. RESULTS: Between antegrade nailing and retrograde nailing in decubitus position, there was a significant difference in the mean discrepancies for the retroversion angles and the range of external rotation of the shoulder in the neutral and abduction positions, but no significant difference for internal rotation of the shoulder and Neer score. Between antegrade nailing and retrograde nailing in supine resting position, there was no significant difference in the mean discrepancy for the retroversion angle. CONCLUSION: Positioning of the arm may significantly affect humeral rotational alignment and range of motion during closed nailing. Until a reliable method for intraoperative measurement of humeral rotation is devised, we recommend that closed nailing of humeral shaft fractures be performed with the patient's upper arm in the resting position shown in this study.

Adolescent↗
PubMed1986

Nonstress test and maternal position.

Antepartum evaluation of 225 low-risk primipara and 262 high-risk primipara and multipara using nonstress testing revealed 53 to be nonreactive when the test was performed in the supine position. When the test was repeated in the lateral decubitus position, it became reactive nonstress testing in 21 of these patients. This group of patients with a supine nonreactive nonstress test and a lateral reactive nonstress test demonstrated an associated compression of the abdominal aorta by the pregnant uterus in the supine, but not the lateral position. This study distinguishes three types of nonreactive nonstress tests: those due to placental insufficiency, those resulting from compression of the abdominal aorta by the pregnant uterus, and the falsely nonreactive. The percentage of false nonreactive nonstress tests results will be reduced by performing the test in the lateral decubitus position.

Aorta, Abdominal↗
PubMed1998

Outcome assessment of an in-hospital cross-functional wound care team.

A multidisciplinary wound care team was developed at the Medical College of Pennsylvania Hospital in 1993 to standardize wound management, appropriately allocate resources, prevent the occurrence of hospital-acquired decubitus ulcers, and effectively manage existing pressure ulcers. This report presents 4 years of prevalence survey data (n = 690 patients over 4 years), which affords an outcome analysis regarding the efficacy of the multidisciplinary wound care team. A significant reduction in the number of patients with pressure ulcers, hospital acquired pressure ulcers, and patients with hospital acquired ulcers occurred. There was, also, a significant improvement in skin integrity documentation, and in the implementation of nutritional assessments. These findings suggest that the multidisciplinary wound care team has been an effective means of gaining some control of decubitus ulcers, which are associated with increased patient morbidity and have an adverse economic impact on hospitals.

Chi-Square Distribution↗
PubMed1997

Shifting percussion dullness of the chest: a sign of pleural effusion.

Early physicians diagnosed pleural effusion by detecting shifting percussion dullness of the chest. However, the lateral decubitus positions have not been routinely used to distinguish this condition from atelectasis or pneumonia. In this report, postural alterations of percussion dullness established the diagnosis of pleural effusion in a 49-year-old patient with a cough. Percussion in the lateral decubitus positions may enhance the value of examinations of the chest.

Humans↗
PubMed1994

Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography.

STUDY DESIGN: The authors hypothesized that the source of coccygodynia was a lesion of the coccygeal disc. OBJECTIVES: This study analyzed the motion of the painful coccyx in the sitting position as compared with the lateral decubitus in a patient and a control group and reported the first results of coccygeal discography (dynamic study). SUMMARY OF BACKGROUND DATA: Coccygodynia are usually attributed to soft tissue injuries or psychologic disturbances. No previous study has assessed the coccygeal discs as a source of pain. METHODS: Fifty-one patients with coccygodynia and 51 controls sustained a dynamic study. Coccygeal mobility was documented by superimposing graph paper with a double reading. The accuracy of the measurement was +/- 2.6 degrees intra- and interobserver variations 15.3 and 12.5%. This dynamic study was followed by coccygeal discography in the patient group. RESULTS: An abnormal motion (luxation or hypermobility) of the coccyx that occurred in the sitting position and spontaneously was reducible when placed in the lateral decubitus position was found in 25 patients. Such lesions could be responsible for the pain because no similar findings were seen in the controls and coccygeal discography was positive in these cases. Of the 26 patients with a normal dynamic study, coccygeal discography, using a combination of provocation and anesthetization, was positive in 15 of 21. CONCLUSIONS: Common coccygeal pain could come from the coccygeal disc in approximately 70% of cases.

Coccyx↗
PubMed2006

Initial experience with video-assisted thoracoscopic surgery for pulmonary metastasis in the prone position.

We performed video-assisted thoracoscopic surgery for pulmonary metastasis with the patient in the prone position because the use of the full lateral decubitus position was not possible owing to a deformity of the upper extremity, which existed because of a previous operation for osteosarcoma. In cases where the lateral decubitus position cannot be used, the prone position is both safe and effective for treating dorsal lesions of the lung by means of video-assisted thoracoscopic surgery.

Adult↗
PubMed2003

Hemodynamic and respiratory effect of pediatric urological laparoscopic surgery: a retrospective study.

PURPOSE: We investigate the impact of extraperitoneal and intraperitoneal CO2 insufflation on cardiopulmonary variables in children undergoing laparoscopic surgery. MATERIALS AND METHODS: The records of 73 patients who underwent laparoscopic urological surgery between December 2000 and April 2002 were retrospectively reviewed. Data collection included respiratory rate (RR), peak airway pressure (PAP), O2 saturation, end tidal CO2 (ETCO2), heart rate, systolic and diastolic blood pressure, electrocardiogram and insufflation pressure. All variables were recorded before and after CO2 insufflation. Only patients with complete records were included in the analysis. RESULTS: The study included 62 participants. Of the patients 16 boys and 13 girls with a mean age +/- SD of 7.2 +/- 5.1 years underwent extraperitoneal surgeries, 14 partial or total nephrectomy and 5 pyeloplasty. Mean retroperitoneal CO2 insufflation pressure was 12.1 +/- 1.5 mm Hg and mean operative time was 3.6 +/- 1 hours. We operated on 13 children on the right and 16 on the left decubitus lateral position. Significant increase in ETCO2, RR and PAP was recorded after CO2 insufflation in the extraperitoneal group. Use of the left lateral position resulted in a significant increase in ETCO2 (37.1 +/- 3.6 vs 40 +/- 3.8, p = 0.04) after CO2 insufflation compared to the right decubitus lateral position. Transperitoneal surgery was performed in 32 boys and 1 girl with a mean age of 3.8 +/- 4.1 years for cryptorchidism (32) and attempted pyeloplasty (1). Mean intraabdominal CO2 insufflation pressure was 11 +/- 2.4 mm Hg and mean operative time was 1.7 +/- 0.8 hours. A significant increase in RR (16.5 +/- 3.1 vs 17.9 +/- 3.4, p = 0.0002) and PAP (13.2 +/- 4.8 vs 16.1 +/- 5.7, p <0.0001), and a decrease in O2 saturation (99.6 +/- 0.6 vs 98.7 +/- 7.1, p = 0.0003) and heart rate (116 +/- 19 vs 113 +/- 18, p = 0.019) were recorded after CO2 insufflation. CONCLUSIONS: Our study documented significant hemodynamic and respiratory changes during pediatric laparoscopic surgeries. A similar effect on the respiratory parameters was observed in both groups. Although there were no apparent complications associated with either approach, further prospective studies are warranted to confirm the effect of laparoscopic urological surgery on cardiopulmonary function in children.

Adolescent↗
PubMed1991

Two cases of diaper area granuloma of the adult.

Two cases of diaper area granuloma are reported. Patient 1, a 34-year-old man, had multiple reddish-purple nodules over the diaper area of the right part of the genitocrural region. Candida albicans was not detected from the lesion. Histological examination of the nodule showed acanthosis and dense infiltrates. The granulomas became smaller and flatter after the control of urination. Patient 2, a 28-year-old man, had two large decubitus lesions and multiple nodules over the diaper area of the gluteal region. The decubitus became smaller and the granulomas disappeared after the lesion was kept clean. Because these granulomas resemble granuloma gluteale infantum, but occurred in adults rather than in the aged or infants, we propose to call this condition "granuloma gluteale adultorum." We suggest that these granulomas may represent an inflammatory reaction to the irritation of urine or feces. It is, therefore, of great importance to treat and prevent this condition by controlling the flow of urine and keeping the region clean.

Adult↗