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Results for “Prone Position”

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PubMed1991

Comparative study on the cardio-respiratory change during prostaglandin E1-induced hypotension in the patients in the supine and prone position.

Prostaglandin E(1)-induced hypotension (25% reduction from the preadministration level in mean arterial pressure) was applied to thirteen patients. Eight patients among them were operated in the supine position (group I) and other five in the prone position (group II). The maintenance dose of PGE(1) was considerably lower in group II than in group I (0.067 micro g.kg(-1).min(-1) vs. 0.119 micro g.kg(-1).min(-1)). In group I, there was a significant increase in CI, with a significant decrease in SVRI and PVRI during PGE(1)-induced hypotension. Such a high dose of PGE(1) (0.119 micro g.kg(-1).min(-1)) was considered to have a direct dilating action on the systemic resistance bed as well as on the pulmonary vasculature. It was considered that the suppression of hypoxic pulmonary vasoconstriction could be a mechanism to increase venous admixture during PGE(1)-induced hypotension. In group II, there was no significant increase in CI, and no significant decrease in SVRI and PVRI. PGE(1)-induced hypotension can be safely applied to the anesthetized patients, but we should be careful to apply it to the patients in the prone position, because lower dose of PGE(1) can induce severe hypotension, which is not accompanied by the increase in CI as occurres in the patients in the supine position.

Journal Article↗

PubMed2002

Brachial plexopathy after prone positioning.

Two cases of brachial plexus injury after prone position in the intensive care unit are described. Mechanisms of brachial plexus injury are described, as are methods for prevention of this unusual complication.

Adult↗

PubMed1997

Prone positioning decreases episodes of hypoxemia in extremely low birth weight infants (1000 grams or less) with chronic lung disease.

Extremely low birth weight infants with chronic lung disease (CLD) have frequent episodes of desaturation (hypoxemia). We quantified oxygenation and episodes of hypoxemia in 55 infants (birth weight < or = 1000 gm) with CLD in the supine versus prone position, for 1-hour time intervals. Oxygen saturation was measured with the Nellcor N-200 pulse oximeter and a computer program. Prone positioning increased oxygen saturation from 92.0% to 94.1% (p < 0.001) and significantly decreased episodes of hypoxemia to oxygen saturation levels of less than 90%, 85%, and 80% (p < 0.001). Our findings support prone positioning for the extremely low birth weight infant with CLD in an intensive care setting.

Chronic Disease↗

PubMed2001

Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome.

BACKGROUND: Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be associated with improved outcome. To fulfil this approach, sedation, neuromuscular blocking agents and full mechanical ventilatory support are often used in critical failure of gas exchange. CASE REPORT: We present a patient who developed multiple organ failure, including severe ARDS, after severe skin injuries and septic shock. Ventilatory strategy consisted of lung protective approach, permissive hypercapnia and prone positioning. Airway pressure release ventilation (APRV) with the patient's superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after application of combined use of APRV and prone positioning. CONCLUSION: APRV and maintenance of patients' spontaneous ventilation is feasible during prone positioning, and this approach may have beneficial synergistic effects on gas exhange in patients with severe acute lung injury.

Adolescent↗

PubMed1996

Awake fibreoptic intubation in the semi-prone position following facial trauma.

A fit 27-year-old man presented with severe facial trauma following an industrial accident. Initial assessment showed severe swelling around the lower jaw and haemorrhage from the mouth, nose, scalp and left ear. The patient was conscious with a Glasgow Coma Score of 13 but in respiratory distress. Following adoption of the prone position his airway improved. Relief of the patient's airway obstruction was a priority and the patient underwent awake fibreoptic intubation in the prone position prior to induction of anaesthesia. Computed tomography scans of his head and neck were unremarkable and after fixation of a bilateral mandibular fracture he made an uneventful recovery. Intubation in the semi-prone position may be a useful technique in injuries of this type.

Accidents, Occupational↗

PubMedDate not supplied

[Prone position: postural treatment for patients with adult respiratory distress syndrome. The nurse's point of view].

The prone position is a therapeutic strategy that can be beneficial in the treatment of adult respiratory distress syndrome (ARDS). In order to evaluate the advantages and possible complications associated with this postural change within the context of nursing, we analyzed retrospectively 71 turns carried out in 32 patients who met criteria for ARDS. The patient was turned by a team of 4 or 5 persons following a strict protocol. The PaO2/FIO2 ratio and SatO2 significantly increased in prone position, without any hemodynamic repercussions. No extubation or loss of vascular accesses or drainage tubes occurred. Complications included: facial edema, low-pressure lesions, and regurgitation of enteral nutrition.

Adult↗

PubMed1999

Anaesthesia in the prone position for impalement injury.

A 22-year-old man was brought to the Emergency Department in the prone position, having been impaled in the right buttock with a large pitchfork. He was in excruciating pain and nauseated; attempts to move the patient or the pitchfork caused severe pain. Caudal blockade was carried out in the prone position, without moving the patient, and proved to be very efficacious. The pitchfork was then removed painlessly, allowing us to turn the patient supine. A conventional induction of general anaesthesia was then made possible.

Adult↗

PubMed1997

Beneficial effects of the prone position on the incidence of barotrauma in oleic acid-induced lung injury under continuous positive pressure ventilation.

BACKGROUND: Factors that contribute to ventilator-induced barotrauma are not well defined. This study investigates the effects of posture on ventilator-induced barotrauma, as well as arterial oxygenation. METHODS: Twelve dogs with oleic acid lung injury, lying in the prone position (n = 6) and right lateral position (n = 6), were mechanically ventilated with continuous positive pressure ventilation for 24 hours. The incidence of pneumothorax and arterial oxygenation were investigated in each position. RESULTS: All animals lying in the lateral position developed pneumothorax in the nondependent thorax, while only one animal in the prone position developed pneumothorax in the left thorax (P < 0.05). Postmortem examination revealed that in the lateral group, the nondependent lung consisted of large areas of emphysematous regions and neutrophil infiltration regions, while the dependent lung was composed of extensive atelectasis and neutrophil infiltration. Lung ruptures occurred in the nondependent lung at the regions of either emphysematous change or severe neutrophil infiltration. In the prone group, in contrast, both lungs were inflated fairly homogeneously with only small areas of atelectatic and emphysematous changes. In the dog in whom pneumothorax developed, lung ruptures were limited to the regions of severe neutrophil infiltration in the left lung. No animal in either group had a peak airway pressure more than 20 cmH2O. The peak airway pressures were 17.5 +/- 1.3 cmH2O in the lateral group and 16.6 +/- 2.1 cmH2O in the prone group (P > 0.05). Tidal volume was comparable between the lateral group (13 +/- 2 ml/kg) and the prone group (12 +/- 1 ml/kg) before pneumothorax occurred (P > 0.05). Arterial oxygenation was much better in the prone group than in the lateral group during the experiment (P < 0.05). CONCLUSION: It was concluded that in lung injury dogs, the prone position has beneficial effects on the incidence of ventilator-induced barotrauma and arterial oxygenation when compared with the lateral position. Ventilator-induced barotrauma may occur at lower airway pressure.

Animals↗

PubMed2005

Prone position improves expiratory airway mechanics in severe chronic bronchitis.

Based on lung parenchyma-airways' interdependence, the present authors hypothesised that prone positioning may reduce airway resistance in severe chronic bronchitis. A total of 10 anaesthetised/mechanically ventilated patients were enrolled. Partitioned respiratory system (RS) mechanics during iso-flow experiments (flow = 0.91 L x s(-1), tidal volume (VT) varied within 0.2-1.2 L), haemodynamics, gas-exchange, expiratory airway resistance (Raw,exp), functional residual capacity (FRC), change in FRC (DeltaFRC), end-expiratory lung volume (EELV), expiratory airway resistance at EELV (Raw,exp,EELV), intrinsic positive end-expiratory pressure (PEEPi), and mean end-expiratory flow were determined in baseline semirecumbent (SRBAS), prone, and post-prone semirecumbent (SRPP) postures. Pronation versus SRBAS resulted in significantly reduced Raw,exp (at VT > or =0.8 L), Raw,exp,EELV (18.3+/-1.4 versus 31.6+/-2.6 cm H2O x L(-1) x s(-1)), inspiratory airway resistance (at VT > or =1.0 L), static lung elastance (at VT < or =0.6 L), "additional" RS/lung resistance (at a range of VTs), DeltaFRC (0.35+/-0.03 versus 0.47+/-0.03 L), EELV (4.92+/-0.49 versus 5.65+/-0.65 L), RS/lung PEEPi (6.7+/-1.1/5.4+/-0.6 versus 8.9+/-1.7/7.8+/-1.1 cm H2O), mean end-expiratory flow (63.9+/-4.2 versus 47.9+/-4.0 mL x s(-1)), and shunt fraction (0.16+/-0.03 versus 0.21+/-0.03); benefits were reversed in SRPP. In severe chronic bronchitis, prone positioning reduces airway resistance and dynamic hyperinflation.

Aged↗

PubMed1994

[Overheating and sudden infant death. Temperature regulation in relation to the prone position, the possible pathogenesis of sudden infant death].

The incidence of sudden infant death syndrome (SIDS) in Denmark varied in the period 1982-1991 between 1.5 and 1.9 per 1000 livebirths. In December 1991 recommendations concerning infants' sleeping position were published by The Danish National Board of Health in order to reduce the risk of SIDS. Babies were recommended to be placed in the supine or side position when sleeping. Parents have followed the guidelines. Most Danish infants are now sleeping on their back or in the side position. Simultaneously, the number of SIDS dropped from about 110 to 40 per year. The incidence decreased to 1.2 in 1992 and was further reduced in 1993 to 0.6 per 1000 live births. Referring to our knowledge of the infant's temperature regulation we discuss why the prone position is a risk factor for SIDS. The head is the site of up to 85% of heat loss in an infant in bed. Placed in the prone position, the infant is more likely to suffer a rise in body temperature, especially if this is combined with having a cold, being heavily wrapped and sleeping in a heated room. Preceding sudden death many infants are reported to have suffered from minor viral infections. These might per se increase the body temperature. Parents often wrap infants that have an infection too heavily, which in an infant sleeping in the prone position might increase the body temperature to a higher level than if sleeping supine. The body temperature influences the production of toxins from normal intestinal flora and from pathogenic bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Temperature Regulation↗

PubMed2001

Superiority of prone position in free-breathing 3D coronary MRA in patients with coronary disease.

Navigator-gated and corrected 3D coronary MR angiography (MRA) allows submillimeter image acquisition during free breathing. However, cranial diaphragmatic drift and relative phase shifts of chest-wall motion are limiting factors for image quality and scanning duration. We hypothesized that image acquisition in the prone position would minimize artifacts related to chest-wall motion and suppress diaphragmatic drift. Twelve patients with radiographically-confirmed coronary artery disease and six healthy adult volunteers were studied in both the prone and the supine position during free-breathing navigator-gated and corrected 3D coronary MRA. Image quality and the diaphragmatic positions were objectively compared. In the prone position, there was a 36% improvement in signal-to-noise ratio (SNR; 15.5 +/- 2.7 vs. 11.4 +/- 2.6; P < 0.01) and a 34% improvement in CNR (12.5 +/- 3.3 vs. 9.3 +/- 2.5, P < 0.01). The prone position also resulted in a 17% improvement in coronary vessel definition (P < 0.01). Cranial end-expiratory diaphragmatic drift occurred less frequently in the prone position (23% +/- 17% vs. 40% +/- 26% supine; P <0.05), and navigator efficiency was higher. Prone coronary MRA results in improved SNR and CNR with enhanced coronary vessel definition. Cranial end-expiratory diaphragmatic drift also was reduced, and navigator efficiency was enhanced. When feasible, prone imaging is recommended for free-breathing coronary MRA.

Adult↗

PubMedDate not supplied

Airway management of a patient with tracheal stenosis for surgery in the prone position.

PURPOSE: When tracheal intubation is required in a patient with an uncollapsible tracheal stenosis, the tip of the tube is usually positioned proximal to the stenosis. Only the tip of the tube may be in the trachea and the tube can be dislodged. We report the successful airway management of a patient with an uncollapsible tracheal stenosis who underwent cranial surgery in the prone position. CLINICAL FEATURES: A 49-yr-old man with the saber-sheath trachea (stenosis of the entire intrathoracic trachea) was scheduled for a posterior fossa surgery for resection of a cerebellar tumour. Anesthesia was induced by allowing the patient to inhale spontaneously oxygen and increasing concentrations of sevoflurane up to 5%, without airway obstruction. After injection of vecuronium, an airway exchange catheter was inserted orally into the trachea. A laryngeal mask airway was then inserted with the exchange catheter in place and, with the aid of a fibrescope, a 6.0-mm reinforced tracheal tube was passed through the laryngeal mask into the trachea so that the tip of the tube was about 1 cm proximal to the stenosis. The patient was turned to the prone position and the operation proceeded uneventfully. CONCLUSIONS: The laryngeal mask and an airway exchange catheter were used as backups to tracheal intubation in this patient with tracheal stenosis in the prone position. Should the trachea be extubated accidentally, it may be re-intubated through the laryngeal mask and ventilation may be possible through the laryngeal mask or the exchange catheter.

Anesthetics, Inhalation↗

PubMed2003

Reverse CPR: a pilot study of CPR in the prone position.

BACKGROUND: Cardiopulmonary resuscitation (CPR), as described in 1960, remains the cornerstone of therapy for cardiopulmonary arrest. Recent case reports have described CPR in the prone position. We hypothesized rhythmic back pressure on a patient in the prone position with sternal counter-pressure (termed reverse CPR here) would increase intra-thoracic pressure and in turn systolic blood pressure (SBP) during cardiac arrest versus standard CPR. METHODS AND RESULTS: Six patients from Columbia Presbyterian Medical Center's Cardiac and Medical Intensive Care Units (CICU and MICU) were enrolled. Eligible patients had suffered circulatory arrest and failed standard CPR for at least 30 min. After enrollment the patients received 15 additional min of standard CPR and then reverse CPR for 15 min. The study's primary endpoint, mean SBP, significantly improved from 48 mmHg during standard CPR to 72 mmHg during reverse CPR (mean improvement=23+/-14 mmHg). Mean calculated mean arterial pressure (MAP) was also improved significantly from 32 mmHg during standard CPR to 46 mmHg during reverse CPR (mean improvement=14+/-11 mmHg). The mean diastolic blood pressure (DBP) improved from 24 mmHg during standard to 34 mmHg during reverse CPR (mean improvement=10+/-12 mmHg). This difference did not meet statistical significance. No patients had return of spontaneous circulation. CONCLUSIONS: Reverse CPR generates higher mean SBP and higher mean MAP during circulatory arrest than standard CPR. These novel findings justify further research into this technique.

Adult↗

PubMed1997

Perforation of the bowel during SWL in prone position.

Perforation of the small bowel during SWL is reported for the first time. The patient was treated in the prone position for a ureteral stone with 4500 shockwaves. There were no underlying or predisposing factors for the damage to the gut with the exception of the large number of shockwaves at a high energy setting. It is concluded that SWL in the prone position with shockwaves traversing the peritoneal cavity carries a risk of damage to the bowel. A reduction of the number of shockwaves and the energy level should be considered in this setting.

Aged↗

PubMed2002

Preliminary results for prone-position breast irradiation.

PURPOSE: To evaluate an alternative prone-position technique for breast irradiation after conservative surgery. METHODS AND MATERIALS: A plexiglas platform with a circular opening for the breast and a double 30 degrees craniocaudal and 10 degrees transverse (left-right for the right breast and right-left for the left breast) slope was evaluated for positioning, the possible use of CT, and dosimetric study in 35 patients with large pendulous breasts who were likely to benefit from irradiation of the breast alone after conservative surgery. RESULTS: The positioning was excellent for all but 3 obese patients who could not achieve adequate prolonged immobilization. The platform height and position made it possible to obtain CT in the other 32 patients. Three-dimensional dosimetry revealed that 85 degrees and 265 degrees angles of the tangential fields for the right breast and 275 degrees and 95 degrees angles for the left breast were adequate for all patients. The use of 4 or 6 MV photon energy and a variety of wedges made it possible to treat the whole breast and the chest wall. The high-dose regions of the base and the top of the breast did not exceed 105%. No interruption was necessary during treatment, and only grade I-II acute skin reactions were observed. CONCLUSION: The results of this study have demonstrated the feasibility of the technique, which has the great advantage of using a similar position for CT scanning and treatment.

Breast Neoplasms↗

PubMed2000

[Ventilation in ARDS: respirator, prone position, NO or artificial lung].

This review discusses the treatment of impaired gas exchange in acute respiratory distress syndrome (ARDS) using conventional ventilation, the open lung approach, prone position, nitric oxide (NO) inhalation and extracorporeal membrane oxygenation (ECMO). It is concluded that ventilation with high inspiratory pressures or volumes should be avoided, and that the open lung approach should be used as the first step. If this does not lead to satisfactory results, prone positioning is recommended, and if life-threatening hypoxemia persists, ECMO could be considered. NO inhalation is not recommended.

Adult↗

PubMed2004

[Case of ventricular tachycardia induced by coronary spasm during surgery in prone position].

A 55-year-old man with hypertension was scheduled for resection of spinal tumor at S1 in the prone position. Anesthesia was induced with midazolam 10 mg, fentanyl 0.2 mg and vecuronium 10 mg, and maintained with sevoflurane 1.5-2% in oxygen 3 l x min(-1) and fentanyl 0.4 mg. When the interspinal ligament was handled, severe ST depression on the ECG was observed for 1 minute, followed by ventricular tachycardia (VT). Immediately, 60 mg of lidocaine was administered intravenously, and ventricular rhythm recovered to sinus rhythm with normal ST level within a few minutes, but the surgery was postponed. In the preoperative examinations, the patient had been evaluated as a low risk case except for a long history of hypertension. Coronary spasm was suspected to have induced VT, because it followed severe ST depression. This experience taught us that in order to avoid critical arrhythmia, patients under general anesthesia, especially those undergoing surgery in the prone position, require particular attention because of the difficulty in cardiac resuscitation.

Anesthesia, General↗

PubMed2004

The role of the lactate dehydrogenase and the effect of prone position during ventilator-induced lung injury.

To examine the impact of lactate dehydrogenase (LDH) as an early marker of ventilator-induced lung injury (VILI) and the effect of prone position during the VILI, we ventilated 28 normal white rabbits (10 supine, 10 prone, 8 controls) for 6 hr or until PaO2/FIO2 ratio was<200 mmHg. We applied an identical injurious ventilatory pattern (peak inspiratory pressure of 35 cmH2O with a PEEP of 3 cmH2O, I:E ratio of 1:2, and FIO2 of 0.40) in the supine and prone group. VILI was assessed by oxygenation, gravimetric analysis and histologic grading. Serum levels of LDH progressively increased significantly during the VILI (supine and prone groups) as compared with controls. There was a significant negative correlation between oxygenation and LDH levels (r=-0.619, p<0.001). Wet weight/dry weight ratios (WW/DW) and histologic scores for dependent regions were significantly higher in the supine than the prone group. There were no differences in WW/DW and histologic scores for nondependent regions between the supine and prone group. These findings suggest that serum LDH levels might be an early marker of severity of lung injury. The prone position resulted in a less severe and more homogenous distribution of VILI.

Animals↗