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Results for “Prone Position”

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PubMed1994

[Effect of dopamine administration on ICG-disappearance rate during prone position anesthesia].

We evaluated the effect of dopamine administration (3 micrograms.kg-1.min-1) on ICG-disappearance rate during prone position in 10 patients undergoing elective spinal cord surgery. Anesthesia was maintained with isoflurane and 50% nitrous oxide in oxygen. ICG-disappearance rate was determined at 3 points, i.e., the day before surgery, during prone position and during the administration of dopamine. Systolic arterial pressure showed no significant difference before and during dopamine administration. ICG-disappearance rate during prone position was significantly lower than the preoperative value. However, ICG-disappearance rate showed no significant difference during dopamine administration and preoperative period. We conclude that dopamine administration may attenuate the depressant effect of the prone position on the hepatic blood flow.

Adult↗

PubMed1997

Additive beneficial effects of the prone position, nitric oxide, and almitrine bismesylate on gas exchange and oxygen transport in acute respiratory distress syndrome.

OBJECTIVE: To test the hypothesis that prone position ventilation, nitric oxide, and almitrine bismesylate, each acting by a different mechanism to improve arterial oxygenation, could exert additive beneficial effects when used in combination in patients with severe acute respiratory distress syndrome (ARDS). DESIGN: Prospective, nonrandomized, interventional study. SETTING: Medical and surgical intensive care units at a university tertiary care center. PATIENTS: Twelve patients with ARDS and severe hypoxemia, defined as PaO2/FIO2 of < or = 150 and FIO2 of > or = 0.6, with pulmonary artery occlusion pressure of < 18 mm Hg. INTERVENTIONS: Inhaled nitric oxide (20 parts per million for 15 mins) in the supine and prone position, and intravenous almitrine bismesylate while prone (1 mg/kg/hr for 60 mins), alone or combined with nitric oxide. MEASUREMENTS AND MAIN RESULTS: Hemodynamic, blood gas, and gas exchange measurements were performed at sequential time points as follows: a) baseline supine; b) nitric oxide in the supine position; c) after return to baseline supine; d) after 30 mins prone; e) after 120 mins prone; f) nitric oxide while prone; g) after return to baseline prone; h) almitrine bismesylate prone; and i) nitric oxide and almitrine bismesylate combined, for 15 mins prone. Patients were considered responders to the prone position if a gain in PaO2 of > or = 10 torr (> or = 1.3 kPa) or a gain in the PaO2/FIO2 ratio of > or = 20 was observed. Seven patients (58%) responded to being turned prone. Compared with supine baseline conditions, nitric oxide and supine position increased arterial oxygen saturation from 89 +/- 1 (SD)% to 92 +/- 3% (p < .05) and nitric oxide plus prone position increased arterial oxygen saturation (94 +/- 3% vs. 89 +/- 4%, p < .05) and decreased the alveolar-arterial oxygen difference from 406 +/- 124 torr (54 +/- 15 kPa) to 387 +/- 108 torr (51 +/- 14 kPa) (p < .05). Almitrine bismesylate increased PaO2/FIO2 vs. baseline (122 +/- 58 vs. 84 +/- 21, p < .05). Almitrine bismesylate decreased the alveolar-arterial oxygen difference vs. baseline from 406 +/- 124 torr (53.9 +/- 16.5 kPa) to 386 +/- 112 torr (51.3 +/- 14.8 kPa) and vs. nitric oxide and supine position from 406 +/- 111 torr (53.9 +/- 14.7 kPa) to 386 +/- 112 torr (51.3 +/- 14.8 kPa) (p < .05). Prone position alone did not improve oxygenation. However, the combination of nitric oxide and almitrine bismesylate increased PaO2/FIO2 vs. nitric oxide supine and nitric oxide prone conditions (147 +/- 69 vs. 84 +/- 25 and 91 +/- 18, respectively; p < .05). In patients responding to the prone position (n = 7), combining nitric oxide and almitrine bismesylate led to further improvement in PaO2 compared with the prone position alone, with PaO2 increasing from 78 +/- 12 torr (10.3 +/- 1.6 kPa) to 111 +/- 55 torr (14.7 +/- 7.3 kPa) (p < .05), which was not the case when either nitric oxide or almitrine bismesylate was added separately. Heart rate and cardiac output were increased by almitrine bismesylate compared with all other measurements. Mean pulmonary arterial pressure was decreased by nitric oxide (27 +/- 7 vs. 30 +/- 7 mm Hg nitric oxide supine vs. baseline supine and 29 +/- 7 vs. 33 +/- 8 mm Hg nitric oxide prone vs. baseline prone, p < .05) and increased by almitrine bismesylate (36 +/- 9 vs. 30 +/- 7 mm Hg baseline supine, 27 +/- 7 mm Hg nitric oxide supine, 33 +/- 8 mm Hg baseline prone, and 29 +/- 7 mm Hg nitric oxide prone; p < .05). The increase in mean pulmonary arterial pressure was totally abolished by nitric oxide (31 +/- 5 vs. 36 +/- 9 mm Hg, p < .05). Minute ventilation, respiratory system compliance, physiologic deadspace, and PaCO2 remained unchanged. CONCLUSION: In ARDS patients with severe hypoxemia, arterial oxygenation can be improved by combining the prone position, nitric oxide, and almitrine bismesylate, without deleterious effects.

APACHE↗

PubMed2001

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

PURPOSE: We shortened the duration of prone positioning after macular hole surgery from one week to one day and evaluated the initial hole closure rate. SUBJECT AND METHOD: The first group included 34 eyes of 33 patients who underwent surgery between April 1998 and August 1999. All 33 patients were instructed to maintain the prone position for one week after surgery (one week group). The second group included 21 eyes of 21 patients who underwent surgery between September 1999 and March 2000. These 21 patients were told to maintain the prone position for 24 hours after surgery (one day group). The indication for surgery was eyes with the reported onset of symptoms within 6 months and without long-standing macular holes. Eyes which underwent retinal pigment epithelium (RPE) or internal limiting membrane (ILM) removal were excluded from the study. Phacoemulsification and intraocular lens implantation were combined in patients with phakic eyes. In the one day group, the patients were instructed to avoid the face up position for one week. RESULTS: There were no significant differences between the two groups in terms of preoperative factors, and initial hole closure rates (i.e., 91.2% in the one week and 90.5% in the one day groups). CONCLUSION: These results suggests that the duration of prone positioning after macular hole surgery can be reduced to as little as 24 hours without RPE or ILM removal in eyes without long-standing holes.

Aged↗

PubMed2007

High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation.

OBJECTIVE: The improvement in oxygenation with prone positioning is not persistent when patients with acute respiratory distress syndrome (ARDS) are turned supine. High-frequency oscillatory ventilation (HFOV) aims to maintain an open lung volume by the application of a constant mean airway pressure. The aim of this study was to show that HFOV is able to prevent the impairment in oxygenation when ARDS patients are turned back from the prone to the supine position. DESIGN: Prospective, comparative randomized study. SETTING: A medical intensive care unit. PATIENTS: Forty-three ARDS patients with a Pao2/Fio2 ratio <150 at positive end-expiratory pressure > or =5 cm H2O. INTERVENTIONS: After an optimization period, the patients were assigned to one of three groups: a) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by a 12-hr period of conventional lung-protective mechanical ventilation in the supine position (CV(prone)-CV(supine)); b) conventional lung-protective mechanical ventilation in the supine position (12 hrs) followed by HFOV in the supine position (12 hrs) (CV(supine)-HFOV(supine)); or c) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by HFOV in the supine position (CV(prone)-HFOV(supine) group). MEASUREMENTS AND MAIN RESULTS: Pao2/Fio2 ratio was higher at the end of the study period in the CV(prone)-HFOV(supine) group than in the CV(prone)-CV(supine) group (p < .02). Venous admixture at the end of the study period was lower in the CV(prone)-HFOV(supine) group than in the two other groups. CONCLUSIONS: HFOV maintained the improvement in oxygenation related to prone positioning when ARDS patients were returned to the supine position.

Aged↗

PubMed1994

Effect of three different surgical prone positions on lung volumes in healthy volunteers.

Ten healthy volunteers were placed in three different surgical prone positions (knee-chest, Eschmann frame and two supports, one each for the thorax and pelvis); the normal prone position without any supports was used as a control. Lung volumes using helium dilution and spirometry were calculated for each volunteer in each position. Compared with the control position, functional residual capacity, expiratory reserve volume, residual volume and total lung capacity were significantly higher in the knee-chest position. Functional residual capacity and expiratory reserve volume were significantly higher in the frame position. No advantage was gained with the use of the two supports position. We conclude that, of these three prone positions in awake volunteers, the knee-chest position causes least respiratory restriction.

Adult↗

PubMed1998

Combined nitric oxide inhalation, prone positioning and almitrine infusion improve oxygenation in severe ARDS.

PURPOSE: To determine the efficacy and side effects of prone positioning (PP) and nitric oxide (NO) inhalation, alone, associated, or combined with i.v. almitrine for the treatment of hypoxaemia in severe acute respiratory distress syndrome (ARDS). METHODS: Over a period of 20 months, 27 consecutive critically ill patients with severe ARDS (Murray score > 2.5, PaO2/FiO2 < 170 after alveolar recruitment) were prospectively and randomly included. They inhaled NO for two hours at concentrations of 5 and 10 ppm for one hour each (H0-H2). One hour later, they were returned to the prone position for four hours (H3-H7). During the last two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation (Group A, n = 9). In group C (n = 9), the procedure for group B was combined with perfusion of 16 mg.kg-1.min-1 almitrine throughout the study. RESULTS: Compared with control values, two hours NO inhalation improves PaO2/FiO2 and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28%, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic parameters remain unchanged, whatever the treatment. NO inhalation improves PaO2/FiO2 by over 20% in 50% of the patients and PP is effective in 78% of the cases. CONCLUSION: Prone Position improves PaO2/FiO2 significantly more than NO alone but less than PP + almitrine or NO + almitrine. The best results are obtained with the association of NO + Prone position + Almitrine.

Administration, Inhalation↗

PubMed2006

Effects of thoraco-pelvic supports during prone position in patients with acute lung injury/acute respiratory distress syndrome: a physiological study.

INTRODUCTION: This study sought to assess whether the use of thoraco-pelvic supports during prone positioning in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) improves, deteriorates or leaves unmodified gas exchange, hemodynamics and respiratory mechanics. METHODS: We studied 11 patients with ALI/ARDS, sedated and paralyzed, mechanically ventilated in volume control ventilation. Prone positioning with or without thoraco-pelvic supports was applied in a random sequence and maintained for a 1-hour period without changing the ventilation setting. In four healthy subjects the pressures between the body and the contact surface were measured with and without thoraco-pelvic supports. Oxygenation variables (arterial and central venous), physiologic dead space, end-expiratory lung volume (helium dilution technique) and respiratory mechanics (partitioned between lung and chest wall) were measured after 60 minutes in each condition. RESULTS: With thoraco-pelvic supports, the contact pressures almost doubled in comparison with those measured without supports (19.1 +/- 15.2 versus 10.8 +/- 7.0 cmH2O, p < or = 0.05; means +/- SD). The oxygenation-related variables were not different in the prone position, with or without thoraco-pelvic supports; neither were the CO2-related variables. The lung volumes were similar in the prone position with and without thoraco-pelvic supports. The use of thoraco-pelvic supports, however, did lead to a significant decrease in chest wall compliance from 158.1 +/- 77.8 to 102.5 +/- 38.0 ml/cmH2O and a significantly increased pleural pressure from 4.3 +/- 1.9 to 6.1 +/- 1.8 cmH2O, in comparison with the prone position without supports. Moreover, when thoraco-pelvic supports were added, heart rate increased significantly from 82.1 +/- 17.9 to 86.7 +/- 16.7 beats/minute and stroke volume index decreased significantly from 37.8 +/- 6.8 to 34.9 +/- 5.4 ml/m2. The increase in pleural pressure change was associated with a significant increase in heart rate (p = 0.0003) and decrease in stroke volume index (p = 0.0241). CONCLUSION: The application of thoraco-pelvic supports decreases chest wall compliance, increases pleural pressure and slightly deteriorates hemodynamics without any advantage in gas exchange. Consequently, we stopped their use in clinical practice.

Adult↗

PubMed2006

Prone position augments recruitment and prevents alveolar overinflation in acute lung injury.

RATIONALE: Mechanical ventilation in the prone position may be an effective means of recruiting nonaerated alveolar units and minimizing ventilation-induced lung injury. OBJECTIVES: To evaluate and quantify regional lung volume alterations when patients with lobar or diffuse acute lung injury (ALI) were turned prone after a recruitment maneuver. METHODS: In 21 patients with ALI, a recruitment maneuver was applied in the supine position followed by a multislice spiral computed tomography (CT) scan; then, patients were turned prone and a second CT scan was performed. MAIN RESULTS: Both the recruitment maneuver and prone position resulted in improved oxygenation in patients with lobar ALI. Prone position also resulted in increased respiratory system compliance and decreased Pa(CO(2)) in lobar ALI. In lobar ALI, the proportion of overinflated and nonaerated areas declined, whereas the proportion of well-aerated areas increased in the prone position. The decrease in overinflated areas was observed mainly in the ventral areas. The dorsal regions showed a decrease in nonaerated areas and an increase in well-aerated areas. Recruitment maneuver and prone position improved oxygenation but had no effect either on Pa(CO(2)) or on the respiratory system compliance of patients with diffuse ALI. These patients responded to prone position with a decrease in nonaerated areas. CONCLUSIONS: Prone position recruited the edematous lung further than recruitment maneuvers and reversed overinflation, resulting in a more homogeneous distribution of aeration. The effects of the prone position were more pronounced in patients with lobar ALI.

Adult↗

PubMed2006

Reduction and pinning of pediatric supracondylar humerus fractures in the prone position.

Supracondylar humerus fractures are common pediatric injuries; the preferred treatment for displaced fractures is closed reduction and percutaneous pin fixation. We present a technique for closed reduction and pinning using prone-patient positioning. Prone positioning facilitates fracture reduction and safe pin placement while avoiding elbow hyperflexion. We prefer this technique to the commonly described method of fracture reduction and pinning with the patient supine.

Bone Nails↗

PubMed2004

Anesthetic management of a patient in prone position with a drill bit penetrating the spinal canal at C1-C2, using a laryngeal mask.

UNLABELLED: Airway management in patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. A 19-yr-old patient was brought to the emergency room in prone position with a drill bit protruding from the posterolateral aspect of his neck. The bit had entered the spinal canal below the first cervical vertebra, and placed near the odontoid peg. He was referred for surgical removal of the drill. The use of an inhaled induction of anesthesia, avoiding muscle relaxants, and ventilation through a laryngeal mask airway inserted in the prone position seemed to offer a satisfactory approach. IMPLICATIONS: Management of patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. Anesthesia may be induced and the airway can be managed with the patient already in the prone position for surgery.

Accidents↗

PubMed1997

Prone position in mechanically ventilated patients with severe acute respiratory failure.

The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.001). After 1 h in a prone position, improvement of PaO2/F(I)O2 by 20 mm Hg or more was considered a positive response. Seven patients studied had no response (22%), hereafter referred to as nonresponders, and 25 had a positive response (78%), hereafter referred to as responders. Among the seven nonresponders, two did not tolerate the prone position and were returned supine before the end of the 4-h trial. With the remaining five, PaO2/F(I)O2 evolution was 83 +/- 29, 77 +/- 19, 83 +/- 33, and 81 +/- 47, respectively. For two of the 25 responders, measurements are missing after returning to the supine position. In 10 of the 23 responders (43%) who completed the 4 h prone trial, the PaO2/F(I)O2 returned to its starting value when patients were repositioned supine: 117 +/- 24, 164 +/- 44, 156 +/- 55, and 110 +/- 34, respectively (ANOVA, p < 0.01). In 13 of the 23 (57%) improvement persisted: 105 +/- 27, 187 +/- 58, 189 +/- 49, and 157 +/- 49, respectively (ANOVA, p < 0.001). Repeated improvements after turning to a prone position were frequently observed. Side effects in the 32 patients after a total of 294 periods in a prone position included minor skin injury and edema, two instances of apical atelectasis, one catheter removal, one catheter compression, one extubation, and one transient supraventricular tachycardia.

Adolescent↗

PubMed2004

Non-invasive measurement of pulmonary blood flow during prone positioning in patients with early acute respiratory distress syndrome.

In the daily clinical routine at the bedside, information on effective pulmonary blood flow (PBF) is limited and requires invasive monitoring, including a pulmonary artery catheter, to determine both cardiac output and intrapulmonary shunt. Therefore we evaluated a non-invasive method for the measurement of PBF in a clinical setting, including 12 patients with acute respiratory failure (acute respiratory distress syndrome) undergoing prone positioning. PBF was determined before (baseline), during and after prone positioning, by using a foreign gas rebreathing method with a new photoacoustic gas analyser. Values were compared with the cardiac output corrected for intrapulmonary shunt (COeff). Responders to prone positioning were defined according to the improvement of arterial oxygenation. A total of 84 measurements were performed. PBF values correlated well with COeff (R2=0.96; P<0.0001). Bias and limits of agreement (+/- 2 S.D.) for all measurements were -0.11 +/- 0.76 litre/min. At baseline, responders showed significantly lower PBF levels than non-responders (4.8 +/- 1.0 compared with. 6.4 +/- 1.2 litre/min; P=0.03). During prone positioning, PBF increased continuously in responders and remained high after patients had been returned to the supine position. PBF was unaffected in non-responders. Mean total increase in PBF was 1.2 +/- 0.2 litre/min in responders compared with -0.4 +/- 0.2 litre/min in non-responders (P<0.0001). In conclusion, the investigated rebreathing system allows for a non-invasive determination of PBF at the bedside. The accuracy of the measurements is comparable with the thermodilution method. It is able to reliably reflect changes in PBF induced by prone positioning. Moreover, measuring PBF might be a promising tool to identify responders to prone therapy.

Adult↗

PubMed2000

The efficacy of cardiopulmonary resuscitation in the prone position.

OBJECTIVE: To ascertain whether cardiopulmonary resuscitation (CPR) is effective when performed on a mannequin in the prone position. METHODS: Thirty six registered nurses each performed 100 consecutive chest compressions on a Laerdal Resusci-Annie mannequin immediately after an annual update of CPR technique from an Advanced Life Support (ALS) instructor. Compressions were performed on a mannequin turned to the prone position, on a standard examination couch. A gel.filled pad was placed between the sternum and couch. Nurses were instructed once to perform compressions in the midline, two.thirds the way up the torso 'between imaginary scapulae'. Efficacy of compressions was measured using an integral 'skillmeter' in the mannequin. RESULTS: Of 3600 chest compressions performed, 3376 were assessed by the skillmeter. 1168 (34.6%) compressions were 4.5 cm in depth, 1370 (40.6%) were 2.4 cm in depth, and 868 (24.6%) were less than 2 cm. Sixty one percent of nurses were able to perform adequate CPR at some stage through the cycle. Forty one percent managed to perform adequate CPR throughout the cycle. CONCLUSIONS: Efficient CPR can be performed on a mannequin in the prone position, although additional instruction in technique is required. This may be applicable to patients turned to the prone position.

Journal Article↗

PubMedDate not supplied

Development of clinical guidelines for prone positioning in critically ill adults.

Literature reveals evidence that prone positioning can improve the oxygenation of critically ill patients suffering from acute lung injury or acute respiratory distress syndrome. Multicentre evidence, however, does not support the claim that it improves patients' outcome. The implementation of multiprofessional guidelines by which to direct the manoeuvre will facilitate the safe and effective management of patients in the prone position. They will thus heighten multiprofessional awareness of the technique and promote its proactive use at such time so as to achieve maximum clinical benefit.

Adult↗

PubMed2004

[Case of circulatory depression in an obese patient in prone position during general anesthesia].

A 25-year-old man [120 kg, 180 cm (body mass index=37 kg x m(-2)] underwent laminectomy and discectomy under general anesthesia in the prone position. Hall frame was used for supporting his body. In spite of a small amount of bleeding, the patient showed metabolic acidosis and hypotension with limb cyanosis one hour after changing position. Ephedrine hydrochloride was effective for the treatment of his hypotension. However, limb cyanosis continued until turning him to the supine position. Anuria continued during prone position. We consider that Hall frame allows patient's abdomen to hang freely, but compresses the body more strongly than expected, especially with heavy patients. It is possible for morbidly obese patients to develop seriously inhibited circulation due to Hall frame. Prone position with careful selection of support system may prevent these complications.

Acidosis↗

PubMed2000

Developmental sequence of postural control in prone position in children with spastic diplegia.

The aim of this study was to assess the development of postural control in the prone position in children with spastic diplegia and triplegia, and determine the influence of clinical characteristics, visual acuity and cognitive performance on that development. We also analysed the relation between these early motor achievements in the prone position and the subsequent acquisition of motor competence in the sitting position. We followed 24 diplegic and triplegic children from before age 2 years (mean age 12 months) to mean age 41 months, videorecording motor behaviour every six months and abstracting acquisitions in alignment and balance using a standardised procedure. We confirm a developmental sequence of all the acquired movements in the prone position. 83.3% of the children completed the uprighting sequence in the sagittal plane, acquired good balance, and ability to rotate the head and trunk. 70.8% of the children (all but one of the diplegic children and none among triplegic children) acquired symmetric posture in the frontal plane and 83.3% reduced leg hyperextension. Development was not uniform, and at 12-18 months two groups began to emerge: diplegic children who rapidly achieved all or most of the steps in the sequence and had a favourable prognosis for subsequent motor development; and triplegic children who achieved these steps at a much slower rate or in some cases not at all and had a less favourable prognosis for future development. Diplegic children with normal visual acuity, and general quotient GQ>70 did better than triplegic children with compromised visual acuity and GQ<70. Acquisition of the full uprighting sequence in the prone position before the age of two related to the later acquisition of autonomous sitting.

Cerebral Palsy↗

PubMed1998

Initial experiences with the retroperitoneal approach for endoscopic nephrectomy with the patient in the prone position.

Retroperitoneal endoscopic nephrectomy with the patient in the prone position was performed in 12 patients. Indications for this procedure were end-stage kidneys with ureteropelvic junction stenosis or distal ureteric obstruction, nonfunctional kidneys with drug resistant renin-mediated hypertension, and distal ureter malignancy. The retroperitoneal area was exposed using an open surgical technique in combination with the use of a liquid-filled dissection balloon. Removal of kidney tissue was performed with a morcellator through one of the ports. On average, the operating time was 210 min (range 160-480 min) to complete a one-sided nephrectomy. No major complications occurred. Mean hospital stay in this series was 6.6 days, and the follow-up period was uncomplicated in all cases. Retroperitoneal endoscopic nephrectomy with the patient in the prone position is an acceptable alternative to open nephrectomy in selected indications.

Adult↗

PubMed2000

An unusual cause of rhabdomyolysis following surgery in the prone position.

Rhabdomyolysis, as a complication of prone positioning of patients during surgery, is rare. Previous case reports have suggested that the common cause of rhabdomyolysis during the postoperative period is ischemic muscle injury resulting from the use of a tourniquet, occlusion of pelvic blood vessels, or prolonged severe hypotension. We present two cases of this occurrence resulting from compression of the thighs by gel pads of the Jackson frame used to position these patients.

Adult↗