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PubMed2001

Relationship between internal risk factors for development of decubitus ulcers and the blood flow response following pressure load.

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the blood flow response following the relief of a pressure load. There were 122 nursing home patients (43 men, 69 women, mean age: 81 +/- 8 years; range: 60-97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardiovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, nutritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and total response time) was measured following relief of a 100 kPa test pressure. The presence of cardiovascular disease, cerebrovascular accident, poor nutritional condition, high serum urea and male gender showed a significant relationship with an impaired blood flow response. The delayed latency found showed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in the blood flow response may result from endothelial damage. A poor nutritional condition may be associated with a deficit of scavengers of oxygen-derived free radicals. The presence of free radicals may damage endothelium during reperfusion, thus influencing the blood flow response. The association of high serum urea with delayed vasodilatation may theoretically be explained by the association of serum urea and impaired kidney functioning, since the kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gender may function as a substitute for other, unmeasured factors that are related to blood flow response.

Age Distribution↗
PubMed1980

Decubitus ulcers and wheelchair cushions a review of the literature.

A review of the literature is presented in this paper discussing the development of decubitus ulcers and wheelchair cushions in their management. The etiology and pathology of decubitus ulcers as well as their classification is outlined. Much research has been done in determining the amount of pressure forces that the skin can survive before becoming ischemic. This is discussed and related to the research evaluating the various cushions available on the market today. This paper is not an endorsement of any particular brand of wheelchair cushion.

Humans↗
PubMed1992

Variation in arterial to end-tidal CO2 tension differences during anesthesia in the "kidney rest" lateral decubitus position.

The course of arterial to end-tidal carbon dioxide tension difference [P(a-ET)CO2] was evaluated during general anesthesia in 25 patients scheduled for renal surgery performed in the "kidney position." The difference between arterial PCO2 (PaCO2) corrected to body temperature, and end-tidal PCO2 (PETCO2) measured by mass spectrometry was assessed after induction of anesthesia, after placement in the lateral decubitus position with back arched over a kidney bridge ("kidney position"), and every 20 min until the patients were replaced in the supine position at the end of the surgical procedure. Heart rate, arterial blood pressure, and esophageal temperature were simultaneously recorded. After induction of anesthesia, when the patients were lying supine (T1), P(a-ET)CO2 was 4.8 +/- 3.9 mm Hg (mean +/- SD). Placing the patients in the kidney position (T2) induced a significant increase in P(a-ET)CO2 (to 7.9 +/- 3.5 mm Hg; P less than 0.01). These alterations occurred without any significant change in mean arterial blood pressure or heart rate. A progressive increase in mean P(a-ET)CO2 occurred with maintenance of anesthesia; P(a-ET)CO2 reached 8.8 +/- 4.1 mm Hg (P less than 0.05 vs T2) and 8.9 +/- 4.4 mm Hg (P less than 0.05 vs T2) at 65 and 85 min, respectively, after lateral decubitus positioning. Large variations between and within patients were observed. Although stable mean arterial pressure was maintained, these changes were associated with a significant decrease in body temperature. These results demonstrate that P(a-ET)CO2 increases when patients are placed in the kidney position and may vary with the prolongation of anesthesia in this situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

The effect of right versus left lateral decubitus positions on induction of spinal anesthesia for cesarean delivery.

UNLABELLED: Induction of spinal anesthesia for cesarean delivery in the left lateral (LL) decubitus position combined with intraoperative left uterine displacement may result in pooling of local anesthetic onto one side of the body. We studied the effect of the right lateral (RL) and LL decubitus positions during placement of spinal anesthesia on the intrathecal spread of 0.5% hyperbaric bupivacaine plus fentanyl in 60 term parturients. Though all parturients acquired a loss of cold sensation at T4 15 min after intrathecal injection, more parturients in the LL group than in the RL group did so at 5 min (P < 0.05). The maximum levels of sensory blockades, amounts of fluid, vasopressor, and supplementary analgesia used, and the incidence of postoperative complications were similar. We conclude that the two positions can be used equally well when hyperbaric bupivacaine and fentanyl are used in cesarean delivery under spinal anesthesia. IMPLICATIONS: We conducted a double-blinded randomized trial comparing the spread of spinal anesthesia placed with a parturient in either the right or left lateral position. There was a faster onset in the left lateral group; however, the maximum block heights and the time taken to achieve them were similar in both groups.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Experimental study of decubitus ulcer formation in the rabbit ear lobe.

An animal model of decubitus ulcer was created with the use of ear lobes of Japanese white rabbits. When the strength of the cyclic compressions and the duration of the cycles of compression and release are adjusted, the model successfully reproduced the four grades used to characterize decubitus ulcer. Compressions were recorded with video microscopy to continuously monitor the changes in tissue blood flow, in both the compressed and surrounding regions. This model is unique insofar as the blood-flow characteristics are clearly visible before, during, and after compression. Because long-term observation is possible in a living-body model, our study can easily be extended.

Animals↗
PubMed2006

Secondary hemophagocytic syndrome in a patient with methicillin-sensitive Staphylococcus Aureus bacteremia due to severe decubitus ulcer.

A 51-year-old man with poliomyelitis was admitted to emergency because of a severe decubitus ulcer on his right hip that was associated with infection. His general condition deteriorated and he was malnourished and dehydrated. Despite adequate hyperalimentation and antibiotic administration, laboratory data indicated pancytopenia 4 days later. He was diagnosed as having secondary hemophagocytosis (HPS) associated with methicillin-sensitive Staphylococcus aureus sepsis due to decubitus inflammation based on bone marrow aspiration and a blood culture. Although granulocyte colony stimulating factor, packed red blood cell transfusions, platelet transfusions, and antibiotics gradually improved the pancytopenia, the patient died of massive gastrointestinal tract bleeding.

Bacteremia↗
PubMed1993

Prevalence and duration of postoperative pneumoperitoneum: sensitivity of CT vs left lateral decubitus radiography.

OBJECTIVE: The purpose of this study was to evaluate the prevalence, location, and duration of pneumoperitoneum in postoperative patients and to compare the sensitivities of CT and left lateral decubitus radiography in the detection of postoperative pneumoperitoneum. SUBJECTS AND METHODS: Twenty-seven CT scans and 27 abdominal radiographs with the patient in the left lateral decubitus position were obtained prospectively in 17 patients after uncomplicated abdominal surgery. Fifteen patients were examined 3 days after surgery and 12 were examined 6 days after surgery. The studies were evaluated in a blinded fashion for the presence, location, and volume of free air. The presence of air on the radiographs and the presence and quantity of air on the CT scans were correlated with each subject's surgical procedure, age, sex, and body habitus. RESULTS: Pneumoperitoneum was seen on 13 (87%) of 15 CT scans and eight (53%) of 15 radiographs obtained 3 days after surgery and on six (50%) of 12 CT scans and one (8%) of 12 radiographs obtained 6 days after surgery. The calculated volume of free air seen on the CT scans ranged from 0.3 to 5.8 ml. Sixty-two percent of collections by volume were located in the midline/parahepatic space, 22% in the pelvis, and 16% in the mesentery. Radiographs showed pneumoperitoneum in only nine (47%) of 19 examinations in which the corresponding CT scans showed free air. Findings on radiographs were false-negative in seven (87%) of eight obese patients in whom pneumoperitoneum was detected on CT scans. CONCLUSION: The prevalence of pneumoperitoneum in the postoperative period based on CT findings is greater than that previously reported. Small amounts of pneumoperitoneum frequently collect along the anterior abdominal wall in two preferential spaces, the pararectus and midrectus recesses. The results of this study show that CT is significantly more sensitive than plain radiography for detecting small amounts of free intraperitoneal air in postoperative patients. Radiography is particularly insensitive for imaging obese and heavy patients.

Adult↗
PubMed1990

[Decubitus].

Since decubitus, one of the common lesions, is not yet fully under medical control, it still offers serious problems. The incidence of this lesion once comprised about 12% of the patients hospitalized in a geriatric institution, and was responsible for the development of sepsis in about 20% of those cases. Although the incidence of this lesion has been declining, it still debilitates many geriatric patients, especially with neurological or malignant diseases. Care being necessary to disperse the pressure on the skin adjacent to the bone, many devices have been invented. The air-fluidized bed is especially effective in preventing and alleviating decubitus. However, a simple device utilizing polyvinyl sponge plates is worthy to try from the standpoint of cost-performance. Several surgical reparative manoeuvres as well as newly developed medicines, such as prostaglandin E1, etc. now promote favourable outcomes. However, the importance of basic preventive care, such as postural change with massage, local hygiene, nutrition, etc. cannot be ignored.

Aged↗
PubMed1996

Efficacy of hydrocolloid occlusive dressing technique in decubitus ulcer treatment: a comparative study.

The efficacy of hydrocolloid occlusive dressing technique was compared with that of the conventional wet-to-dry gauze dressing technique in decubitus ulcer of stage I and II. Forty-four patients were randomly divided into two treatment groups and each received treatment according to the two different protocols. As a result, 80.8% of the hydrocolloid occlusive dressing group (group 1) and 77.8% of the conventional wet-to-dry gauze dressing group (group 2) healed completely with no statistically significant difference between the two groups. However, the time required for complete healing was shorter in group 1 with 18.9 days compared to 24.3 days in group 2. Ulcer healing speed was also slightly faster in group 1 with 9.1 mm2/day compared to 7.9 mm2/day for group 2. Average treatment time spent by a medical staff member was significantly shorter in group 1 with 20.4 minutes/day compared to 2017 minutes/day in group 2. The hospital cost of the ulcer treatment was higher in group 2 compared to group 1 even without taking into consideration the medical personnel's labor cost. These results indicate that the hydrocolloid occlusive dressing technique offers less time consuming and less expensive method of treatment compared to the conventional technique in stage I and II decubitus ulcers.

Adult↗
PubMed1999

[Ventilation in prone decubitus in a patient with respiratory distress during heart surgery].

Acute respiratory failure and adult respiratory distress syndrome are serious complications after heart surgery and are associated with a high mortality rate. We report the case of a 50-year-old man who developed severe respiratory distress after heart surgery with extracorporeal circulation and for whom oxygenation was possible with ventilation in prone decubitus position only after other therapeutic measured had failed. The physiological bases of ventilation in prone decubitus position, as well as the indications and contraindications of the technique are discussed. Early treatment, which is fundamental for managing these patients, facilitates a favorable outcome as is illustrated by the case we report.

Cardiotonic Agents↗
PubMed1999

[Decubitus ulcer. Basic treatment intervention is pressure unloading].

With an incidence of between 3 and 34%, decubitus ulcers are common chronic wounds, many of which can be avoided by prophylactic measures. The most effective preventive measure is relieving pressure on the endangered part of the body, and this is most easily achieved by regularly changing the patient's position in bed. Since, however, this is not always possible for staff-shortage or illness-related (e.g. fractures of the spine) reasons, modern pressure-relieving systems are being increasingly used. The range of options extends from simple foam plastic underlays to water-filled cushions to pneumatic cushions or beds filled with tiny glass beads. Selection of the most appropriate system is often difficult. For effective prophylaxis, determination of the individual risk of developing a bedsore with the aid of special scales makes good sense. In this way, the measures required can be adapted to the particular needs of the individual patient. New approaches to decubitus ulcer prevention and wound management may help to ensure effective care of the endangered or affected patient.

Adolescent↗
PubMed2000

[Application of nursing care products in decubitus prevention].

Pathophysiological factors of decubitus development determine general risk situation of individuals. Working principle and used material of common used antidecubitus systems can have a strong influence on individual risk potential. This study gives an overview about individual advantages and disadvantages in working principle, which may be used by different technical devices for decubitus prevention.

Bedding and Linens↗
PubMed1975

Heterotopic bone formation about the hip and unilateral decubitus ulcers in spinal cord injury.

Of 131 patients having spinal cord injury who were admitted to the hospital for chronic symptoms over a two-year period, 62 (47 percent) developed heterotopic ossifications in hip muscles. Of these 62 cases, 51 were unilateral. In 83 (63 percent) of the 131 patients, decubitus ulcers developed and these were unilateral in 71 cases. A high correlation between ulceration and heterotopic ossification was observed (phi = 0.69, P less than 0.001). Because heterotopy in the absence of ulceration was infrequent (less than 1 percent of cases), it appears that ossification and reduced mobility of a limb predipose to the development of the decubitus ulcer.

Adolescent↗
PubMed1975

Thermographical investigation of decubitus ulcers.

1. Posterior body reference thermograms indicate that in general a similar thermal body pattern of humans does exist. 2. The buttocks, hips, and thighs of a nude subject are thermally cool regions, possibly indicating poor vascular circulation and/or large fat concentrations. 3. Thermograms of the same anatomical area on the same subject under controlled environmental conditions are thermally similar. 4. The scapular region is from 1 to 2 deg F hotter than the sacral region for subjects reclining on Mylar. 5. The 1 deg temperature differential thermograms and the reference thermogram while the subject is on Mylar, in many ways, denote the geometrical shape of the underlying bone structure, especially the bones of the scapulae and sacrum. 6. On the degree temperatue differential thermograms, the anatomical regions most accused of being decubitus ulcer prone are the regions of highest temperatures: the scapulae, sacrum, elbows, and calves. 7. During reactive hyperemia, the visible red flare over the sacrum and coccyx becomes very intense in the first few minutes and then gradually diminishes. The thermal flare persists longer than the visible flare. The extended duration of the thermal flare over the visible red flare is attributed to a continued local elevated metabolic tissue rate caused by the previous engorgement of blood. 8. The thermal mottling seen in the first minute after releasing the load is believed to have been caused by the rapid infusion of blood and the dilation of affected vessels responsible for making up the blood flow debt which occurred during the period of ischemia. 9. A posterior body heating effect noticed immediately after the subject left the Mylar film has been attributed to the insulative qualities of the film. The cooling effect is more difficult to explain, but it is thought that the higher than average room temperature caused an increased evaporative cooling rate response of the two subjects either before getting off the film or immediately after getting off and therefore reduced the temperature of the skin. 10. The maximum reactive hyperemic temperature difference, the difference between the initial standing reference thermogram and the maximum flare temperature observed during tissue hyperemia, may be as high as 12 deg F. 11. Males on the average have larger flare patterns than females, 5.7 in.2 and 4.7 in.2, respectively. The flare areas were computed from thermograms taken 2 to 3 minutes after off-loading of tissue. 12. With the average distance from the buttock's fold to the highest and lowest thermal flare indication being lower for females (3.2 and 5.9) than for males (3.8 and 6.4), a relationship between the site or decubitus ulcer formation and the pelvic bone structure of the sexes may well exist. 13. No two thermal flare patterns are similar either in size or in shape. Thermal flare patterns occur along the centerline of the body at the sacrum and coccyx level. 14...

Adolescent↗
PubMed2000

The effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus.

OBJECTIVE: To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus (AD). METHODS: The study population consisted of three groups: 20 individuals without cardiovascular studied as group I. Group II included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction (EF) > 50% were studied as group III. Group II and III were matched for age, EF and extent of coronary artery disease. RESULTS: Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction (1/3FF) was significantly lower in group III than in group II and I (both P < 0.001), but LV late 1/3 FF was much higher in group III than in group II and I (P < 0.05, P < 0.01). Left ventricular end-diastolic pressure (LVEDP) was markedly increased before and after LVG in group II and III as compared with group I (both P < 0.05, both P < 0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD) before and after LVG was much higher in group III than in group I ( P < 0.01, P < 0.001). However, there we significant differences in LVEDP and in LACPD between before and after LVG only in group III (both P < 0.01). CONCLUSION: The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.

Adult↗
PubMed1992

New perspectives in the treatment of decubitus ulcers.

Although the consequences of prolonged lying on a hard surface are as old as the human race, publications on this subject are scarce. This is due to the fact that a decubitus ulcer never occurs in isolation but is nearly always a complication of some other condition. The term "decubitus" was already used by Hildnaus in 1590 and is derived from the Latin word decumbere which means "lying down". The most important fact to keep in mind is that pressure sores can be prevented. This is the reason why this article not only discusses the management of pressure sores but also the importance of preventive measures. The basis of effective treatment is early detection and an adequate knowledge of the fundamental pathological process. Only adequate preventive measures, careful examination of the lesions, and a thorough knowledge of the products used can avoid unnecessary suffering by patients.

Aged↗
PubMedDate not supplied

Management of urinary tract infections, decubitus ulcer and pneumonia in the aging person.

Infections in the older person are common and a significant cause of morbidity and mortality. Infections of the urinary tract, skin and soft tissue infections including decubitus ulcers, antibiotics associated diarrhea and lower respiratory tract infections are particularly important in the elderly because of their frequency. While most initial antibiotic therapy is empiric, its important before treatment to try to document the etiology for better use of antibiotics. Infections of the urinary tract are frequently and potentially serious in the elderly, they must be separated from asymptomatic bacteriuria that requires no therapy. Upper and lower urinary tract infections are frequently caused by aerobic gram negative bacilli and or enterococci. Most authors prefer the use of fluoroquinolones to manage such infections. The elderly with decubitus ulcer presents a problem in management, since these are frequent polymicrobic infections in which anaerobes play an important role. The initial therapy usually involves the combination of a fluoroquinolone plus an antianaerobic agent like clindamycin. C. difficile diarrhea as frequent in nursing home residents as well as the older person with prior antibiotics. The treatment should be with metronidazole and avoid the use of vancomycin. Pneumonias in the elderly can be acquired in the community, the nursing home or during a hospitalization. The etiologic agents that predominate change from S. pneumoniae and atypicals in those from the community to an increase in gram negative pneumonia. The initial treatment as started by most authors as well as guidelines include the use of a new fluoroquinolone like gatifloxacin alone or in combination with a beta-lactamic agent like ceftriaxone. For those infections acquired in the hospital therapy with third or fourth generation cephalosporins, carbapenems, beta-lactams with betalactamase inhibitors alone or in combination with an aminoglucoside and or vancomycin if MRSA is suspected is accepted therapy.

Aged↗
PubMed2005

[Decubitus ulcers and wounds. Ethical and legal features].

The author presented a conference at the 5th National Symposium on Bedsores, or Decubitus Ulcers, and Chronic Injuries. In our country there is no specific regulation on the medical-sanitary responsibility regarding decubitus ulcers, or bedsores, and other injuries; rather these regulations are covered by more general legal concepts such as the civil responsibility according to articles 1902 and 1903.4 of the "CC", the patrimonial responsibility the State has for the normal or abnormal functioning of the Sanitary Administration, and penal responsibility.

Delivery of Health Care↗