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PubMed1978

Effects of body position change on thoracoabdominal motion.

With a linearized respiratory magnetometer, measurements of anteroposterior and lateral diameters of both the rib cage and the abdomen were made at functional residual capacity and continuously during tidal breathing. Twenty-five subjects with normal respiratory systems were studied in the sitting, supine, lateral decubitus, and prone body positions. When subjects changed from sitting to supine position anteroposterior diameters of both rib cage and abdomen decreased while their lateral diameters increased. Both anteroposterior and lateral tidal excursions of the rib cage decreased; those of the abdomen increased. When subjects turned from supine to lateral decubitus position both anteroposterior diameters increased and the lateral diameters decreased. This was associated with an increase in both lateral excursions and a decrease in the abdominal anteroposterior excursions. Diameters and tidal excursions in the prone position resembled those in the supine position. Diameter changes could be explained by gravitational effects. Differences in tidal excursions accompanying body position change were probably related to 1) differences in the distribution of respiratory muscle force, 2) differences in the activity or mechanical advantage of various inspiratory muscles, and 3) local compliance changes in parts of the rib cage and abdomen.

Abdomen↗
PubMed1979

Lung interdependence and lung-chest wall interaction of sublobar and lobar units in pigs.

In anesthetized and paralyzed pigs in the left decubitus position we obstructed, at functional residual capacity (FRC), either the right middle and lower lobes, or a small posterior basal lung unit, and then passively inflated the unobstructed remaining lung. Measurements were made of alveolar pressure in the obstructed and unobstructed lung regions as well as of esophageal pressure. The tendency of the obstructed lung region to inflate as the remainder of the lung was inflated was assessed by an index (A), which was the end-inspiratory pressure difference between unobstructed and obstructed alveolar pressures, normalized by the change in elastic recoil of unobstructed lung. With the chest wall intact, inflation of unobstructed lung resulted in a tendency to inflate the obstructed regions. This tendency was abolished with the chest wall removed. In a second group of pigs with the basilar lung unit obstructed, the height of the unit was changed by turning a pig from right to left decubitus positions. In each position A was assessed with both spontaneous and positive pressure ventilation. The magnitude of A was found to vary directly with the magnitude of caudal diaphragmatic motion and was greatest with the lung unit dependent and with spontaneous ventilation. These results suggest that lung-chest wall interaction was a more important factor tending to preserve homogenous inflation than lung tissue interdependence.

Animals↗
PubMed1979

Ventilation-perfusion relationship in young healthy awake and anesthetized-paralyzed man.

Distributions of ventilation and perfusion relative to Va/Q were determined in seven young healthy volunteers (24-33 yr) while they were either in the supine or right lateral decubitus position. The subjects were studied first awake and then while anesthetized-paralyzed and breathing 30% oxygen and again while breathing 100% oxygen. In the awake state, no statistically significant differences were observed in the distribution of ventilation and perfusion relative to Va/Q between the supine and right lateral decubitus positions or on changing the inspired oxygen concentrations. After induction of anesthesia-paralysis, Va/Q mismatching increased significantly but only small right-to-left intrapulmonary shunts developed. Ventilating the lungs with 100% oxygen further increased the dispersion of blood flow distribution during anesthesia-paralysis; lung units with low Va/Q or right-to-left intrapulmonary shunts (or both) developed. With induction of anesthesia-paralysis and intubation of the trachea, the anatomic dead space was decreased and the alveolar dead space increased.

Adult↗
PubMed1983

Gravity dependence of phases III, IV, and V in single-breath washout curves.

The gravity dependence of phases III (IIIa and IIIb), IV, and V of simultaneously performed He-bolus and N2-resident gas single-breath washout curves was studied in different body positions by the technique of 180 degrees body inversion between inspiration and expiration. Phase IIIa was mainly determined by nongravitational factors. Phase IIIb was influenced by gravitational, as well as nongravitational, factors. The former were more important with the bolus method in both lateral decubitus positions and the latter with the N2 method in the prone and supine positions. Phases IV and V were mainly gravity dependent. The difference in gravity dependence between the He and N2 methods appeared to be correlated with the vertical interregional concentration gradients of both gases; indeed the vertical gradient was larger for the 133Xe bolus inhaled at residual volume (which is comparable to the He-bolus distribution) than for the 133Xe residual volume-to-total lung capacity ratio (which is comparable to the N2-resident gas distribution). The greater gravity dependence in the lateral decubitus positions than in the supine or prone postures was related to the larger vertical interregional concentration difference as well as to the more pronounced sequential ventilation in the former positions. Finally the negligible effect of gravity on phase IIIa, its moderate effect on phase IIIb, and its predominant effect on phases IV and V were in agreement with the increased sequential filling and emptying due to gravity near residual volume.

Adult↗
PubMed1991

Regional blood flow to canine parietal pleura and internal intercostal muscle.

Transcapillary Starling forces in the parietal pleura and the underlying interstitium may potentially contribute to the exchange of fluid across this barrier. However, the extent of blood flow to the parietal pleura has not been measured. Thus, using standard microsphere techniques, we compared blood flow to the parietal pleura, including the subpleural interstitium, with blood flow to the adjacent internal intercostal muscle, as well as with flows to other serous tissues, including mediastinal pleura, pericardium, and parietal peritoneum, in anesthetized dogs that were either breathing spontaneously (n = 9) or ventilated to control arterial PCO2 (n = 5). Blood flow (ml.min-1.g-1) was measured after 20 min of equilibration in four successive body positions: right lateral decubitus, supine, left lateral decubitus, and prone. Overall, flow to parietal pleura was not different in spontaneous [1.07 +/- 0.14 (SE)] and mechanically ventilated animals (0.74 +/- 0.11). Flow to the internal intercostal muscle was significantly less than pleural blood flow, averaging 0.24 +/- 0.03 and 0.16 +/- 0.03 in the same groups, although again there was no effect of ventilation mode. Blood flow to other serous tissues in the thoracic cavity, specifically the mediastinal pleura (0.67 +/- 0.14) and pericardium (0.88 +/- 0.22), was similar to parietal pleural flow, whereas that to the parietal peritoneum was an order of magnitude lower (0.09 +/- 0.02, P less than 0.05). Changing body position had no effect on blood flow to any of the sampled tissues. Blood flow to the dorsal aspect of the chest wall muscle in spontaneously breathing animals tended to be greater than that to lateral or ventral portions of the chest wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Spatial distribution of ventilation and perfusion in anesthetized dogs in lateral postures.

We aimed to assess the influence of lateral decubitus postures and positive end-expiratory pressure (PEEP) on the regional distribution of ventilation and perfusion. We measured regional ventilation (VA) and regional blood flow (Q) in six anesthetized, mechanically ventilated dogs in the left (LLD) and right lateral decubitus (RLD) postures with and without 10 cmH(2)O PEEP. Q was measured by use of intravenously injected 15-microm fluorescent microspheres, and VA was measured by aerosolized 1-microm fluorescent microspheres. Fluorescence was analyzed in lung pieces approximately 1.7 cm(3) in volume. Multiple linear regression analysis was used to evaluate three-dimensional spatial gradients of Q, VA, the ratio VA/Q, and regional PO(2) (Pr(O(2))) in both lungs. In the LLD posture, a gravity-dependent vertical gradient in Q was observed in both lungs in conjunction with a reduced blood flow and Pr(O(2)) to the dependent left lung. Change from the LLD to the RLD or 10 cmH(2)O PEEP increased local VA/Q and Pr(O(2)) in the left lung and minimized any role of hypoxia. The greatest reduction in individual lung volume occurred to the left lung in the LLD posture. We conclude that lung distortion caused by the weight of the heart and abdomen is greater in the LLD posture and influences both Q and VA, and ultimately gas exchange. In this respect, the smaller left lung was the most susceptible to impaired gas exchange in the LLD posture.

Aerosols↗
PubMed1975

Regional and total lung function studies in patients with hemidiaphragmatic paralysis.

Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.

Activities of Daily Living↗
PubMed2002

Aging attenuates the vestibulosympathetic reflex in humans.

BACKGROUND: The vestibular system contributes to sympathetic activation by engagement of the otolith organs. However, there is a significant loss of vestibular function with aging. Therefore, the purpose of the present study was to determine if young and older individuals differ in their cardiovascular and sympathetic responses to otolithic stimulation (ie, head-down rotation, HDR). We hypothesized that responses to otolithic stimulation would be attenuated in older adults because of morphological and physiological alterations that occur in the vestibular system with aging. METHODS AND RESULTS: Arterial blood pressure, heart rate, muscle sympathetic nerve activity (MSNA), and head rotation were measured during HDR in 11 young (26 +/- 1 years) and 11 older (64 +/- 1 years) subjects in the prone posture. Five older subjects performed head rotation (chin to chest) in the lateral decubitus position, which simulates HDR but does not alter afferent inputs from the vestibular system. MSNA responses to HDR were significantly attenuated in older as compared with young subjects (P<0.01). MSNA increased in the older subjects by only 12 +/- 5% as compared with 85 +/- 16% in the young. Furthermore, HDR elicited significant reductions in mean arterial blood pressure in older (Delta-6 +/- 1 mm Hg; P<0.01) but not young subjects (Delta1 +/- 1 mm Hg). In contrast to HDR, head rotation performed in the lateral decubitus position did not elicit hypotension. MSNA responses to baroreceptor unloading and the cold pressor test were not different between the age groups. CONCLUSIONS: These data indicate that aging attenuates the vestibulosympathetic reflex in humans and may contribute to the increased prevalence of orthostatic hypotension with age.

Adult↗
PubMed1999

Variation in the arousal pattern after obstructive events in obstructive sleep apnea.

The relationship between the severity of obstructive sleep apnea (OSA) (measured by sleep study) and daytime sleepiness is poor. Variation in the degree of arousal accompanying obstructive respiratory events might help explain this poor correlation. Polysomnographic records from patients with OSA were reviewed in order to extract representative examples of apneas and hypopneas (in 10 patients), as well as events both supine and decubitus (in 12 patients). The EEG accompanying each obstructive event was processed with a neural network technique to describe sleep depth on a second-by-second basis. The lengths of any visually evident microarousals were also measured manually. There was considerable interindividual variation in the degree of sleep disturbance using the neural network technique (p < 0.005), but not using the lengths of the visually scored microarousals (p = 0.6). The arousals accompanying apneic events caused greater variability in sleep depth quantified using the neural network technique (p = 0.03), and also lasted longer based on the visual scoring (mean, 12.6; SD, 1.7 s) than the hypopneic events (mean, 9.9; SD, 2.4 s; p = 0.02). There were no significant differences between events occurring supine versus decubitus with either technique (p = 0.7). These differences in arousal magnitude may explain some of the poor correlations between conventional measures of sleep apnea severity and daytime sleepiness.

Arousal↗
PubMed1976

Airway visualization by tantalum inhalation bronchography.

A novel technique for the generation of tantalum aerosols (aerodynamic mass median diameter, 5.8 mum; sigma g, +/-2.14) for inhalation bronchography via the mouth was applied in 26 anesthetized dogs. Ventilatory patterns during periods of aerosol inhalation were controlled by either bilateral electrophrenic stimulation of the diaphragm (EPS), or by intermittent, negative pressure at the body surface (INPV). We studied patterns of tracheobronchial deposition with regard to both the sites of particle deposition longitudinally along airways within lobes, and the topographic distribution of aerosol among the lung lobes. Bronchographic patterns were accordingly studied after inhalations by either (1) EPS and INPV in the supine posture with constant tidal volumes, but varied inspiratory flow (30 to 90 liter per min); or (2) EPS with constant tidal volume and peak inspiratory flow in the prine, right, and left lateral decubitus body positions. Under all airflow conditions, the aerosol was deposited on the surfaces of ciliated airways. Deposition was nearly entirely confined to subsegmental bronchi and above with vigorous inspirations, but extended distally to subsegmental bronchi in greater proportion with decreases in the inspiratory flow. Airways among the basal lung lobes were particularly subject to distal subsegmental and bronchiolar deposition with low rates of inspiratory airflow. Regionally, the aerosol was deposited preferentially in dependent lung lobes after inhalations with EPS in the right and left lateral decubitus positions, and in the basal lung lobes with EPS in the supine posture. A greater caudocranial uniformity in lobar aerosol distribution occurred with inhalations by INPV in the supine posture, and by EPS in the prone posture. The canine model strongly suggests that for clinical inhalation bronchography, nonhomogeneities in lobar deposition may be averted by inhalations in multiple body positions, and that deposition of the aerosol may be confined to ciliated airway surfaces by inertial impaction accompanying high rates of inspiratory airflow.

Aerosols↗
PubMed1979

The clinical usefulness of a screening test to detect static pulmonary blood using a multiple-breath analysis of diffusing capacity.

We devised a screening test to detect static blood in the lungs (e.g., with pulmonary vascular obstruction or pulmonary hemorrhage). A back pressure to CO will develop in static blood as the concentration of carboxyhemoglobin increases with time, and diffusing capacity (DLCO) will decrease. Instead of obtaining a single value for DLCO, we calculated DLCO over small decrements of the exhaled vital capacity during 4 sequential breaths using a modification of a method developed in our laboratory. In each of 5 healthy subjects there was no difference in DLCO during the 4 sequential breaths in the sitting, supine, or lateral decubitus positions. However, in a patient with a proved pulmonary embolus, DLCO decreased with sequential breaths, expecially at low lung volumes. In a patient with angiographic evidence of kinking of the left pulmonary artery when he assumed the right lateral decubitus position, DLCO showed a sequential decrease in this position only. Three patients with pulmonary hemorrhage also showed decreases in DLCO during sequential breaths during episodes of active bleeding.

Adult↗
PubMed1982

The effects of posture on total respiratory compliance.

In 6 subjects, a minimum of 10 determinations of total respiratory compliance by the weighted spirometer technique was made in four different body positions: seated, supine, right lateral decubitus, and left lateral decubitus. The mean total respiratory compliance was 0.097 +/- 0.018 1/cmH2O; the mean individual coefficient of variation was 8%. There was no significant change in the total respiratory compliance with change in posture in any individual or in the group as a whole. In 6 patients with pulmonary disease, the total respiratory compliance determined by this technique and derived from measurements using the esophageal balloon was not significantly different. It is concluded that total thoracic compliance does not vary with posture in normal subjects, and that the weighted spirometer technique is reproducible and clinically applicable.

Humans↗
PubMed1982

Validation of respiratory inductive plethysmography using different calibration procedures.

We devised a new calibration procedure [least squares method (LSQ)] for respiratory inductive plethysmography (RIP) and compared it with our previously reported simultaneous equation method (SEQ) of analyzing data in 2 body positions and with the method of Stagg and associates using the analysis of individual breaths in a single body position. The values from RIP were compared with simultaneous spirometry (SP) in 20 normal subjects placed in the standing (STD), supine (SUP), sitting, prone, semi-recumbent, right lateral decubitus, and left lateral decubitus postures. The LSQ gave the most accurate results followed closely by SEQ. In addition, LSQ was compared with the isovolume angle maneuver (ISV) calibration procedure in supine (ISV-SUP) and standing (ISV-STD) postures. Each of the 10 normal subjects breathed at tidal volumes of 250, 750, and 1,250 ml in the SUP and STD postures. Of the values obtained by the LSQ method, 93% were within +/- 10% of SP in SUP and STD positions. Without a change in the posture in which the calibration was made, 83% of values with ISV-SUP and 90% of values with ISV-STD were within +/- 10% of SP. When body position was changed, 65% of the values obtained with ISV-SUP and 38% of the values obtained with ISV-STD were within +/- 10% of SP. With the LSQ, 45% of isovolume angles in SUP and STD position were within 45 +/- 3 degrees; 40% of isovolume angles with ISV-SUP and 60% with ISV-STD were within 45 +/- 3 degrees when body position was changed from position calibrated. In estimating fractional contribution of rib cage and abdominal compartments. LSQ was comparable to ISV in the standing posture but generally gave lesser values for the rib cage contribution in the supine posture than ISV. The optimal calibration procedure for respiratory inductive plethysmography in terms of accuracy and ease of subject performance is the least squares calibration procedure.

Calibration↗
PubMed1984

Influence of head-dependent positions on lung volume and oxygen saturation in chronic air-flow obstruction.

We investigated the influence of head-dependent positions upon functional residual capacity (FRC) and arterial oxygen saturation in 25 patients with clinically stable chronic air-flow obstruction and 25 normal subjects. Lung volume was measured by gas dilution in normal subjects and by plethysmography in patients with chronic obstructive pulmonary disease (COPD). Arterial oxygen saturation was determined by ear oximetry. In normal subjects, sitting FRC declined by 29.9% when a horizontal-supine posture was assumed, but underwent little further change as the supine subject was tilted head-downward to -25 degrees. Lateral decubitus positions caused declines from sitting FRC of 17.1% at 0 degrees, and 27.4% at -25 degrees. In contrast, patients with COPD experienced negligible changes in lung volume as position was varied. The mean falls from sitting FRC were 3.5% and 1.9% in the 0 degree supine and 0 degree lateral decubitus postures, respectively, and little further volume loss occurred in head-dependency. Eight patients actually increased FRC when recumbent. Positional lung volume changes measured by gas dilution exceeded those measured by plethysmography, suggesting that increased air trapping helped to maintain FRC as position was altered. Patients with COPD did not desaturate in any position tested. We conclude that patients with advanced COPD conserve lung volume and do not desaturate when tipped into head-dependent positions. Reduction of FRC is unlikely to contribute to the hypoxemia or dyspnea previously reported to occur in these patients during chest physiotherapy.

Female↗
PubMed1994

Can a survey influence quality of care in nursing homes? The impact of the New York Quality Assurance System on resident deterioration and adverse outcomes.

Data from a standardized administrative form, the Patient Review Instrument, were used to evaluate whether the New York Quality Assurance System (NYQAS) had an impact on deterioration in functional status or on the incidence of adverse outcomes among residents in New York's nursing homes. The NYQUAS approach evaluated nursing homes by using "triggers" suggestive of deficient quality of care. A random sample of nursing home facilities was selected from data encompassing 2 years before and 2 years after the implementation of NYQAS in 1988. Growth curve analysis and logistic regression were used to assess the influence of NYQAS on deterioration and on the probability of developing decubitus ulcers or contractures, or of being mechanically restrained. The functional status of most residents did not change significantly over time. After allowing statistically for differences in the resource needs of residents within the facilities, the implementation of NYQAS was associated with decreased deterioration in toileting and/or transferring, depending on the site of care. NYQAS was not associated with changes in incidence rates of decubitus, contractures, or the use of mechanical restraints.

Activities of Daily Living↗
PubMed1999

An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures.

The objective of this study was to examine and characterize limb-threatening lower extremity wound or soft tissue complications after coronary artery bypass (CABG) and determine risk factors for their cause. While minor wound problems of the leg after CABG are not uncommon, serious limb-threatening complications, though less frequent, do occur and are often de-emphasized in the surgical literature. A review of 1090 consecutive CABG procedures performed from January 1, 1995 through December 31, 1995 was instituted, which screened for limb-threatening lower extremity wound or soft tissue complications defined as wounds that: required additional surgery for treatment; prolonged the length of stay; or which required lengthy home health nursing for treatment. Minor lymph leaks, leg swelling, infections or wound problems treated as an outpatient were excluded. Of 1090 patients, 54 (5.0%) experienced a limb-threatening lower extremity complication. Complications were categorized as vein harvest incision non-healing (n = 36, 66.7%), decubitus ulceration (n = 11, 20.4%), forefoot ischemia/embolization (n = 10, 18.5%), groin hematoma/abscess (n = 6, 11.1%), severe cellulitis (n = 3, 5.6%), or a combination (n = 12, 22.2%). Statistically significant risk factors by univariate and bivariate analysis for a complication included older age (68 years vs 62 years, p = 0.007), female sex (57% vs 28%, p < 0.001), diabetes (57% vs 33%, p = 0.005) and longer pump time (129 min vs 114 min, p = 0.009). These complications necessitated five major lower extremity amputations and nine revascularization procedures. Chronic lower extremity ischemia from peripheral vascular disease (PVD) was a major contributing factor for the development of wounds in at least 23 (42.6%) of these patients, though suspected in only 10 (43.5%) preoperatively. A non-healing vein harvest incision below the knee of a patient retrospectively found to have inadequate distal circulation for healing occurred in 17 (31.5%) of the total 54 cases. It was concluded that non-healing vein incisions, decubitus ulcers and forefoot ischemic lesions frequently occurring in older diabetic females with undetected pre-existing PVD, comprise the majority of limb-threatening leg complications after CABG. Nearly one-third of the complications may have been avoided had the vein harvest incision not been made at the ankle of a patient with unappreciated PVD.

Age Distribution↗
PubMed2006

Body position and jaw posture effects on supra- and infrahyoid electromyographic activity in humans.

The purpose of this study was to record the pattern of electromyographic (EMG) activity of supra- and infrahyoid muscles at different body positions and jaw posture tasks. The sample included 22 healthy subjects with natural dentition, bilateral molar support, and absence of posterior occlusal contacts during mandibular protrusion. Bipolar surface electrodes were located on the left supra- and infrahyoid muscles for EMG recordings. In each subject EMG activity was recorded while standing and in the lateral decubitus position, during the following jaw posture tasks: swallowing of saliva, maximal clenching in the intercuspal position, grinding from intercuspal position to protrusive edge-to-edge contact position, and grinding from retruded contact position to intercuspal position. Suprahyoid EMG activity was significantly higher in the intercuspal position than in all the other jaw positions studied (mixed model with unstructured covariance matrix). Suprahyoid EMG activity was similar in both body positions studied. Infrahyoid EMG activity in the intercuspal position was significantly higher than grinding from intercuspal position to protrusive edge-to-edge contact position, similar to swallowing of saliva, and significantly lower than grinding from the retruded contact position to intercuspal position. Infrahyoid EMG activity in the lateral decubitus position was significantly higher than in the standing position. The EMG pattern observed could be of clinical importance in the presence of parafunctional habits, i.e., clenching and/or grinding. The neurophysiological mechanisms involved are discussed.

Adult↗
PubMed1991

Level of spinal anesthesia can be predicted by the cerebrospinal fluid pressure difference between full-flexed and non-full-flexed lateral position.

We studied whether cerebrospinal fluid pressure difference between full-flexed and non-full-flexed lateral position (dP) influences the spread of intrathecally (i.e., spinal) administered anesthetic solution (SSA). Forty-two women, 18-60 yr old, who underwent gynecologic surgery under spinal anesthesia were enrolled in the study. They were divided into two groups (group 1: less than 40 yr old, group 2: greater than or equal to 40 yr old). Before spinal anesthetic injection, we measured the pressure difference produced by postural change from the right lateral decubitus position (non-full-flexed) for needle insertion at the L2-3 interspace to a full-flexed lateral decubitus position with a spinal needle in place. After they returned to the non-full-flexed lateral position, 14 mg of plain tetracaine in 10% dextrose solution (2.8 mL) was injected intrathecally in each patient. Pressure differences had a significant correlation with the cephalad levels of spinal anesthesia in each group; the larger pressure difference was associated with a larger SSA. The relationship was stronger in the younger group (correlation coefficients, 0.82 and 0.63; P-values less than 0.01 in groups 1 and 2, respectively). Three patients in group 1 developed T-2 anesthesia, whereas no one in group 2 did (P less than 0.01), and their pressure difference values ranged from 12 to 16 cm H2O, substantially larger than those of the other patients in group 1. Five patients in group 2 developed T-3 anesthesia, whereas no patient in group 1 (P less than 0.01) did, and their pressure differences were not essentially larger than those of the rest in the same group. The authors conclude that pressure differences correlated with the SSA, although the mechanism remains to be clarified. It seems possible to predict which patient in the younger patient group may develop unintentional high spinal anesthesia (T-3 or higher) by measuring pressure differences.

Adult↗