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At least 19 recordsLinked to original sources
PubMed2004

[Comparison of lateral position and prone position ventilation in patients with acute lung injury/acute respiratory distress syndrome].

OBJECTIVE: To evaluate the clinical result of lateral position ventilation and prone position ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients. METHODS: Twenty-four patients were allocated to two groups, with one group (n = 13) receiving lateral position ventilation after April 2002, and the other (n = 11) received prone position ventilation before March 2002. Respiratory and circulatory indices were monitored after position changes and compared between the two groups. RESULTS: One hour after position change PaO(2) was elevated in both groups; in the lateral position group from (103 +/- 12) mm Hg to (126 +/- 13) mm Hg (P < 0.01), and in the prone position group from (87 +/- 19) mm Hg to (119 +/- 15) mm Hg (P < 0.01). If a 10 mm Hg increase was regarded as the standard of treatment effectiveness, then the effective rate in the lateral position group was 61.5% and in the prone position group was 63.6%, the difference being not significant. CONCLUSION: As auxiliary means in the treatment of ALI/ARDS, lateral position and prone position ventilation showed similar effects, but the lateral position was more convenient for practice and medical care, thus needs further investigation.

Adult↗
PubMed1988

Pneumatosis in the descending colon: preliminary observations on the value of prone positioning.

Prone positioning is valuable for accurate diagnosis of intramural air in the descending colon. In the supine position, partial collapse of the descending colon can minic intramural air. Conversely, complete collapse of the descending colon eliminates the interface between intraluminal and intramural air so that the recognition of intramural air is obscured. The tendency for the descending colon to distend with gas in the prone position may reduce these false positives and negatives for intramural air.

Air↗
PubMed2004

Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion.

UNLABELLED: A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning. IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.

Adult↗
PubMed2004

Pressure on the face while in the prone position: ProneView versus Prone Positioner.

STUDY OBJECTIVE: To measure the surface pressure on the face of a patient placed in the prone position with the most commonly used prone positioning devices, a non-face-contoured positioner (PP) and a new face-contoured device (PV). DESIGN: Prospective, randomized comparison. SETTING: Operating room in an American academic medical center. SUBJECTS: 35 randomly recruited adult volunteers. INTERVENTIONS: Surface pressure on the face was measured in awake subjects placed in the prone position, with the head and neck in the position of most comfort, using both the PP and PV devices. MEASUREMENTS: Surface pressure was obtained using an array of small transducers imbedded in a thin cushion that was interfaced between the face and positioning device. The amount of extension or flexion of the head on the neck was estimated using an angular measurement of eye-ear line and horizontal line. MAIN RESULTS: The average surface pressure on the face was less with the PV than with the PP (21 +/- 3 mmHg vs. 27 +/- 5 mmHg; p < 0.0001). The number of areas where pressure exceeded 30 mmHg and 50 mmHg was lower for the PV than the PP (15 +/- 7.5 areas vs. 19 +/- 7.2 areas > 30 mmHg; p < 0.05; 5.2 +/- 3.3 areas vs. 9.0 +/- 5.0 areas > 50 mmHg; p < 0.0001). Pressure on the chin increased with extension of the head or neck (p < 0.05) with both devices. CONCLUSIONS: Surface pressure on the face in the prone position is 29% higher with the non-face-contoured PP than with the face-contoured PV. The number of areas on the face where the surface pressure is greater than 50 mmHg is 80% higher with the PP than the PV. Small degrees of head extension increases pressure on the chin. Both devices produce areas of pressure, typically over the chin, which may be associated with local skin damage. Keeping the head and neck in a non-flexed, non-extended position may minimize pressures.

Equipment Design↗
PubMed2003

Neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle in patients positioned prone.

PURPOSE: To study accelerographic monitoring of neuromuscular blockade over the vastus medialis muscle in anesthetized patients in the prone position. METHODS: Sixty adult patients were divided into four groups of 15: prone (P)-post-tetanic count (PTC), P-train-of-four (TOF), supine (S)-PTC or S-TOF group. In the P-PTC and P-TOF groups, the muscular branch of the femoral nerve was stimulated and the movement of the vastus medialis muscle was measured accelerographically. In the S-PTC and S-TOF groups, the depth of neuromuscular blockade was assessed mechanically at the thumb. After administration of vecuronium 0.1 mg.kg(-1), TOF stimuli were delivered every 20 sec in all groups. Onset of neuromuscular blockade (time from vecuronium to the minimum level of T1 (first response of TOF) was compared between the P-PTC or P-TOF group and S-PTC or S-TOF group. Recoveries of PTC and those of TOF were compared between the P-PTC and S-PTC groups and P-TOF and S-TOF groups, respectively. RESULTS: Onset of neuromuscular blockade in the P-PTC or P-TOF group was shorter than in the S-PTC or S-TOF group (132 +/- 43 vs 233 +/- 40 sec, mean +/- SD, P < 0.001). Recoveries of PTC in the P-PTC and S-PTC groups followed a similar time course. Recoveries of T1/control in the P-TOF and S-TOF groups were also comparable. In contrast, train-of-four ratio (T4/T1, TOFR) in the P-TOF group was higher than in the S-TOF group 60-120 min after vecuronium (P < 0.05). CONCLUSIONS: The degree of neuromuscular blockade can be assessed accelerographically over the vastus medialis muscle even when patients are in the prone position. When evaluated accelerographically over the vastus medialis muscle, onset of neuromuscular blockade is quicker and TOFR is higher than that assessed at the thumb.

Analysis of Variance↗
PubMed2001

Morbid obesity and the prone position: a case report.

An improperly positioned prone patient can experience serious impairment of cardiopulmonary function. However, with appropriate preparation, even an extremely obese patient can safely tolerate the prone position.

Adult↗
PubMed2000

Prone position endoscopic transthoracic release with simultaneous posterior instrumentation for spinal deformity: a description of the technique.

STUDY DESIGN: A prospective series of 15 consecutive adult patients with spinal deformity who underwent endoscopic transthoracic release with simultaneous posterior instrumentation while positioned prone. OBJECTIVES: To describe the technique and clinical results of endoscopic transthoracic release performed with the patient prone (as opposed to lateral) on the concave side for scoliosis or on either side for kyphosis, with simultaneous posterior exposure, instrumentation, and correction of the deformity. SUMMARY OF BACKGROUND DATA: Use of endoscopic surgical techniques is rapidly advancing across all subspecialties. These techniques can be used to expose and operate on the spine in a less invasive fashion, thus avoiding damage to other tissues and facilitating earlier mobilization and rehabilitation. Current endoscopic techniques with the patient in the lateral decubitus position mimic open thoracotomy. A new technique is described with the patient positioned prone, which allows simultaneous posterior exposure. METHODS: Preoperative Cobb angle or thoracic kyphosis angle, maximal correction bending films, and postoperative Cobb angle or kyphosis angle were measured and compared. All perioperative morbidity, intraoperative complications, and surgical variables were prospectively documented and analyzed. RESULTS: There were no intraoperative technical problems with the endoscopic equipment or instruments and no immediate, 6-month, or 2-year postoperative complications related to the endoscopic component of the procedure. In the scoliosis patients, the average correction was 60%. In the kyphosis patients, the average correction was 39%. CONCLUSIONS: Transthoracic endoscopic techniques, compared with thoracotomy, offer a less invasive method of accessing the anterior spinal column, with the benefits of an excellent view of the area of the spine being instrumented, minimal soft tissue disruption, and an improved cosmetic result. With the simultaneous technique, staged or subsequent procedures can be eliminated, and a circumferential structural release as well as control of the mobilized spine can be achieved. This simultaneous technique can be extended for use in correction of a variety of thoracic spinal pathologies.

Adolescent↗
PubMed2003

Three-dimensional conformal breast irradiation in the prone position.

The prone position can be used for the planning of adjuvant radiotherapy after conservative breast surgery in order to deliver less irradiation to lung and cardiac tissue. In the present study, we compared the results of three-dimensional conformal radiotherapy planning for five patients irradiated in the supine and prone position. Tumor stage was T1N0M0 in four patients and T1N1M0 in one. All patients had been previously submitted to conservative breast surgery. Breast size was large in three patients and moderate in the other two. Irradiation in the prone position was performed using an immobilization foam pad with a hole cut into it to accommodate the breast so that it would hang down away from the chest wall. Dose-volume histograms showed that mean irradiation doses reaching the ipsilateral lung were 8.3+/-3.6 Gy with the patient in the supine position and 1.4+/-1.0 Gy with the patient in the prone position (P = 0.043). The values for the contralateral lung were 1.3+/-0.7 and 0.3+/-0.1 Gy (P = 0.043) and the values for cardiac tissue were 4.6+/-1.6 and 3.0+/-1.7 Gy (P = 0.079), respectively. Thus, the dose-volume histograms demonstrated that lung tissue irradiation was significantly lower with the patient in the prone position than in the supine position. Large-breasted women appeared to benefit most from irradiation in the prone position. Prone position breast irradiation appears to be a simple and effective alternative to the conventional supine position for patients with large breasts, since they are subjected to lower pulmonary doses which may cause less pulmonary side effects in the future.

Breast Neoplasms↗
PubMedDate not supplied

Shortening the duration of prone positioning after macular hole surgery- comparison between 1-week and 1-day prone positioning.

PURPOSE: To shorten the duration of prone positioning after macular hole surgery from 1 week to 1 day, and to evaluate preoperative factors and the initial hole closure rate. METHODS: The subjects were 33 patients (34 eyes) who underwent macular hole surgery between April 1998 and August 1999, and maintained the prone position for 1 week (1-week group) and 21 patients (21 eyes) who underwent this operation between September 1999 and March 2000, and maintained the prone position for only 1 day (1-day group). The criteria for macular hole surgery were no more than 6 months since symptom development and no flattening of the fluid cuff. Eyes treated by removal of the retinal pigment epithelium (RPE) or internal limiting membrane (ILM) were excluded. In all phakic eyes, cataract surgery was combined with macular hole surgery. In the 1-day group, the patients maintained the prone position for 1 day and were instructed to avoid only the supine position for the subsequent 1 week. RESULTS: Preoperative factors possibly affecting the hole closure rate did not differ significantly between the two groups. Initial hole closure rates were similar in the 1-week (91.2%) and 1-day (90.5%) groups. CONCLUSION: In eyes without symptoms of long duration, the duration of prone positioning after macular hole surgery may be shortened to 1 day even without using special techniques, such as removal of the RPE or ILM, in combination with macular hole surgery.

Aged↗
PubMed2002

Bifrontal epidural haematomas following surgery for occipital falcine meningioma: an unusual complication of surgery in the prone position.

A 25 year old lady underwent surgery for a left occipital falcine meningioma. The patient was positioned prone and following an occipital carniotomy, total excision of the tumour was performed. In the postoperative period, she developed bifrontal epidural haematomas, for which surgical evacuation was performed. Intracerebral haematomas distant from the site of craniotomies are uncommon and epidural haematomas are extremely rare. The literature is reviewed and the possible mechanisms causing this complication are discussed.

Adult↗
PubMed1998

The vanishing heart--deterioration on chest radiography with clinical improvement during prone position ventilation.

Prone position ventilation is used in the treatment of ARDS. Its beneficial effects are due to increased ventilation of the dorsal lung areas. Consequently, the now dependent parts of the lungs collapse, resulting in decreased sharpness of the cardiac silhouette. The latter may be misinterpreted as a worsening of the cardiopulmonary condition while, in fact, gas exchange and ventilation may be markedly improved. These features are illustrated in the case presented.

Adult↗
PubMed2001

[Comparison between the anterior chamber configuration in the supine position and that in the prone position in patients with narrow angle].

PURPOSE: To determine whether the anterior chamber configuration of patients with narrow angle is changed in the prone position. PATIENTS AND METHODS: The study included 16 eyes of 16 patients whose anterior chamber angle was classified as Shaffer 2 or narrower. The prone position test(PPT) and ultrasound biomicroscopy (UBM) were performed on every subject. In the UBM examination, the following parameters were measured both in the supine position and in the prone position: the angle-opening distance at 250 microns from scleral spur(AOD 250), the angle-opening distance at 500 microns from scleral spur(AOD 500), the trabecular-iris angle(TIA), and the anterior chamber depth at the center of the cornea(anterior chamber depth, ACD). RESULTS: While the intraocular pressure was higher after PPT than before the test, every subject was evaluated as negative for PPT. Mean value of every parameter examined was lower in the prone position than in the supine position(AOD 250: 114 microns, vs. 128 microns, AOD 500: 121 microns vs. 144 microns, TIA: 12.1 degrees vs. 15.5 degrees, ACD: 1966 microns vs. 2002 microns), and the change in ACD was statistically significant (p = 0.013). CONCLUSIONS: The anterior chamber configuration of patients with narrow angle is changed in prone position. Such a change can occur in patients classified as negative for PPT.

Aged↗
PubMedDate not supplied

The endoscopically assisted simultaneous posteroanterior reconstruction of the thoracolumbar spine in prone position.

BACKGROUND CONTEXT: The reconstruction of the anterior column of the thoracolumbar spine has become more common in the last few years, due largely to the unfavorable results of exclusively posterior surgical treatment, which has been associated with a lack of about 10 degrees of kyphosis correction after removal of the instrumentation. The minimally invasive anterior techniques have reduced the morbidity of the anterior approach significantly. PURPOSE: A minimally invasive technique for anterior stabilization of the spine may reduce the morbidity of the open approach. Irrespective of an anterior open or an endoscopic approach, the posteroanterior instrumentation of thoracolumbar fractures requires time-consuming intraoperative maneuvers to change the patient position from prone to lateral. We describe here a standardized anterior endoscopically assisted approach for the segments T4 to L4. This approach allows the patient to remain in prone position. A 4- to 5-cm incision combined with a retractor system is used. STUDY DESIGN/SETTING: In a prospective study, all patients of our clinic who underwent surgery of the thoracolumbar spine between July 1999 and May 2001 were registered. Study criteria were duration of surgery, duration of anesthesia, intra- and postoperative complications. PATIENT SAMPLE: Between July 1999 and May 2001, 42 patients (25 male, 17 female, average age of 41.9 years), who presented with 55 injured spinal levels and underwent surgery of the thoracolumbar spine in prone position, were included. OUTCOME MEASURES: Duration of surgery (posterior/anterior/total), duration of anesthesia, method of instrumentation, intra- and postoperative complications, postoperative hospital stay and radiographs were evaluated. METHODS: Surgery was performed in prone position. A thoracic approach was used for instrumentation of T9 to L2. A retroperitoneal approach was used for stabilization of L1 to L5. Both procedures were endoscopically assisted with a new retractor system (Synframe; Synthes GmbH, Umkirch, Germany). In this manner, only an incision 4 to 5 cm long and a stab incision for the endoscope were required. The whole procedure was performed in prone position without a change of position during surgery. RESULTS: A total of 42 patients underwent surgery following this technique: 14 isolated anterior procedures (median duration of surgery, 181 minutes); 13 simultaneous one-stage procedures (median duration of surgery: 210 minutes) and 15 combined two-stage procedures (median duration of surgery: 90 minutes posterior, 120 minutes anterior, 240 minutes posterior+anterior). In the simultaneous posteroanterior procedures, the anterior instrumentation was performed 20 times using one rod, twice using two rods and in six patients simply by bone grafting. No intraoperative complications were observed. In the postoperative course, one case of pneumothorax, one case of hemothorax and one case of transient intercostal neuralgia occurred. CONCLUSION: The approach to the anterior spine in prone position is feasible by using a self-holding retractor system for the region between T4 and L4. The duration of anesthesia for the one-stage simultaneous procedure was reduced by about 40 minutes, because changing the position of the patient is no longer necessary. The minimal incision, in combination with the retractor system, significantly reduces cost by allowing the use of less expensive instruments and implants. The advantages of the open and the endoscopic techniques are combined, while their disadvantages are minimized. The main advantage of the prone position is the opportunity to access the anterior and posterior spine simultaneously, which is especially helpful in reduction maneuvers.

Adult↗
PubMed2002

[Endoscopically assisted minimally invasive reconstruction of the anterior thoracolumbar spine in prone position].

Irrespective of an anterior open or endoscopic approach, the combined postero-anterior instrumentation of thoracolumbar fractures requires time consuming intraoperative maneuvers changing the patients position from prone to lateral.A standardised anterior endoscopically assisted approach for the segments Th4 to L4 is described, allowing the patient to remain in prone position, using a 4-5cm incision combined with a retractor system. The approach to the anterior spine in prone position is feasible by using a self holding retractor system for the region from Th4 to L4. Time of anaesthesia for the one stage combined procedure can be reduced by about 40 min, when changing the position of the patient is no longer necessary. The minimal incision in combination with the retractor system allows mainly the use of conventional instruments and implants, which provides reasonable lower costs. The advantages of the open and the endoscopical technique are combined. The main advantage of the prone position is the opportunity to access the anterior and posterior spine simultaneously, which is extremely helpful in reduction maneuvers.

Adult↗
PubMed2003

Prone positioning made easy.

Prone positioning of patients may optimise exposure for certain surgical procedures. There have been many published works that discuss the advantages of prone ventilation and how to nurse a patient who is lying in the prone position. However, there are very few empirical studies that describe how to place a patient in the prone position. This article outlines the problems and describes a safe and efficient manoeuvre that minimises the risks, following moving and handling principles (DoH 1992).

Humans↗
PubMed2005

Effect of body position on gas exchange in patients with idiopathic pulmonary alveolar proteinosis: no benefit of prone positioning.

BACKGROUND: Prone positioning may improve oxygenation in patients with acute lung injury/ARDS. However, the beneficial effect of prone positioning on gas exchange has never been investigated in patients with diffuse pulmonary infiltrates who breathe spontaneously. OBJECTIVE: To evaluate the effect of body position on gas exchange in patients with idiopathic pulmonary alveolar proteinosis (PAP) with special reference to the benefit of prone positioning. DESIGN: A prospective study. SETTING: Tertiary medical center. PATIENTS AND METHODS: Eight patients with PAP were studied on 25 occasions using spirometry, body plethysmography, and single-breath diffusing capacity of the lung for carbon monoxide (Dlco). Arterial blood gas levels were measured in the sitting position and in four lying positions randomly while patients breathed room air. To serve as control subjects, 16 age-matched healthy hospital personnel were studied. To evaluate the impact of oxygen therapy on positional effect in gas exchange, arterial blood gas levels were measured in the supine and prone positions in some PAP patients while breathing 40% oxygen. RESULTS: Normal to varying degrees of restrictive ventilatory defect and gas exchange impairment, as evidenced by Dlco, Pao(2), and alveolar-arterial oxygen pressure difference (P[A-a]O(2)), were found in PAP patients. The ventilatory function parameters correlated positively with Pao(2) and negatively with P(A-a)O(2). The values of Pao(2) and P(A-a)O(2) measured in four lying positions showed no significant difference in both PAP patients and healthy control subjects. Furthermore, the differences in Pao(2) and P(A-a)O(2) between measurements made in the supine and prone positions and the ratio of Pao(2) measured in the prone position/Pao(2) measured in the supine position were comparable between PAP patients and healthy control subjects. Arterial blood gas levels showed no significant difference between measurements made in PAP patients in the supine and prone positions while breathing 40% oxygen. CONCLUSIONS: Positional change did not significantly affect gas exchange, and no benefit of prone positioning was found in both PAP patients and healthy control subjects. Further studies are needed to verify the benefit of prone ventilation in patients with diffuse pulmonary disorders who breathe spontaneously.

Adult↗