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At least 325 records · Page 18Linked to original sources
PubMed2003

Prognostic factors in acute respiratory distress syndrome: a retrospective multivariate analysis including prone positioning in management strategy.

OBJECTIVE: To investigate the prognostic factors in acute respiratory distress syndrome (ARDS) patients focusing on the use of prone positioning (PP). DESIGN AND SETTING: Retrospective study conducted in an intensive care unit of a university hospital. PATIENTS: All consecutive mechanically ventilated ARDS patients surviving on day 7 after the diagnosis of ARDS. METHODS: The study included all ARDS patients who survived more than 7 days after ARDS diagnosis between January 1995 and December 2002. Demographic and respiratory variables were collected on day 1, and the management of ARDS was analyzed during the first 7 days ( n=125). We performed a univariate analysis and a stepwise logistic regression analysis comparing survivors and nonsurvivors on day 28 and at 2 and 6 months. RESULTS: Mortality rates on day 28 and at 2 and 6 months were 21.6%, 32%, and 44% respectively. A SAPS II score less than 49, McCabe score, and the use of PP introduced in the first 7 days of ARDS management appeared to be independently correlated with a decrease in mortality. CONCLUSIONS: The SAPS II score, the McCabe score, and use of PP are independently correlated with the outcome in ARDS patients.

Critical Care↗
PubMed1993

[Efficacy of external cardiac massage in a patient in the prone position].

This paper reports a case of successful CPR performed in a female patient in the prone position during the excision of a cerebellar meningioma. It was realised by means of an external, posterior thoracic compression below the left shoulder-blade, without any anterior compression as described in two previous reports.

Cerebellar Neoplasms↗
PubMed2003

Effects of expiratory rib cage compression and/or prone position on oxygenation and ventilation in mechanically ventilated rabbits with induced atelectasis.

INTRODUCTION: Expiratory rib cage compression is a chest physiotherapy technique known as "squeezing" technique in Japan. It has been claimed that rib cage compression effectively treats and/or prevents lung collapse, but no studies have been reported on rib cage compression focused on improving ventilation and/or oxygenation in subjects with collapsed lung. Therefore, we studied whether rib cage compression, with and without prone positioning, improves the ratio of P(aO)(2) to fraction of inspired oxygen (P(aO)(2)/F(IO)(2)), P(aCO)(2), or dynamic compliance of the respiratory system. METHODS: We used anesthetized adult rabbits with induced atelectasis. An endotracheal tube and an 18-gauge catheter were placed into the airway via a tracheostoma, and pressure-controlled mechanical ventilation was used. To create atelectasis, artificial mucus was infused into the airway via the catheter. The rabbits were randomly assigned to one of 4 groups ( = 10 in each group): (1) supine without rib cage compression, (2) supine with rib cage compression, (3) prone without rib cage compression, and (4) prone with rib cage compression. Each rib cage compression session lasted for 5 min and was repeated 5 times every 30 min. After these interventions for 180 min all animals were placed in the supine position for 120 min. RESULTS: The prone-position groups had significantly higher P(aO)(2)/F(IO)(2) than the supine-position groups at 60 min after the beginning of the intervention, and at 60, 90, and 120 min after the end of the intervention (p < 0.05). Rib cage compression did not significantly affect P(aO)(2)/F(IO)(2), P(aO)(2), or dynamic compliance. CONCLUSIONS: It is unlikely that rib cage compression re-expands collapsed lung. Prone positioning improved oxygenation in rabbits with induced atelectasis.

Animals↗
PubMed1982

Upper extremity prone position exercise as aerobic capacity indicator.

Peak oxygen uptake of prone upper extremity exercise (VO2peak arm) compared with maximal oxygen uptake of upright lower extremity cycling (VO2max leg) was examined in an unselected young healthy male population (n = 21). The large standard deviation of the mean value of VO2peak arm expressed as a percentage of VO2max leg (60.48% +/- 11.84%) discourages use of a maximal upper extremity exercise test to predict total body aerobic capacity (r = 0.595 p = 0.002). However, the relationship between VO2peak arm and VO2max leg was influenced by the individual's cardiorespiratory fitness and capacity to perform either arm or leg work. When the population was divided into subgroups according to cardiorespiratory fitness or when subjects previously trained for either arm or leg work were excluded from analysis, the predictive power of VO2peak arm improved. (r = 0.946 p less than 0.001). Study results suggest that with careful analysis of subjects' fitness prior to upper extremity exercise testing, such exercise in a prone position can indicate aerobic capacity and may be used for fitness training when lower limb disabilities exist.

Adult↗
PubMed2000

Prone positioning for acute respiratory distress syndrome in the surgical intensive care unit: who, when, and how long?

BACKGROUND: We evaluated the effects of prone positioning (PP) on surgery and trauma patients with acute respiratory distress syndrome (ARDS). METHODS: Patients with ARDS were studied. Exclusion criteria were contraindications to PP. Patients were evaluated in the supine position and after being turned to the PP. After 6 hours, patients were returned to the supine position for 3 hours. One hour after each position change, arterial and mixed venous blood was drawn and analyzed for blood gases and pH, and hemodynamics were measured. RESULTS: Over 20 months, 27 patients met the criteria, and 20 of the patients were entered into the study. On day 1, 18 of 20 patients (90%) responded with an increase in PaO(2) during PP. On day 2, 16 of 17 patients (94%) responded; on day 3, 15 of 16 patients responded (94%); on day 4, 11 of 13 patients responded (85%); on day 5, 8 of 8 patients responded (100%); and on day 6, 4 of 5 patients responded (80%). Pao(2)/Fio(2) and Qs/Qt were significantly improved (P<.05) during PP. There were 91 periods of PP, lasting 10.3+/-1.2 hours. Of 91 changes to PP, 78 changes (86%) resulted in an improvement in Pao(2)/Fio(2) of more than 20%. CONCLUSIONS: PP improves oxygenation in ARDS for 6 days with few complications.

Adult↗
PubMed2004

Severe acute respiratory distress syndrome in a child with malaria: favorable response to prone positioning.

We present the case of a 4-year-old boy with malaria who developed acute respiratory distress syndrome with severe hypoxemia refractory to mechanical ventilation and inhaled nitric oxide. Placing the patient in prone position immediately and persistently improved oxygenation: the ratio of P(aO(2)) to fraction of inspired oxygen rose from 47 to 180 mm Hg and the oxygenation index decreased from 40 to 11. The patient survived, with no respiratory sequelae.

Child, Preschool↗
PubMed2002

Retroperitoneoscopic nephrectomy in the prone position in children (point of technique).

We describe our initial experience with retroperitoneoscopic procedures in children in the prone position. Twelve children (five girls and seven boys; mean age 3.5 years) underwent nephrectomy, nephroureterectomy or heminephroureterectomy for obstruction or reflux within the non-functioning kidney, multicystic dysplastic kidney or upper pole dysplastic moiety. None of the operations were converted to an open procedure. The mean operative time for these procedures was 110 minutes. Blood loss was less than 20 ml.

Child↗
PubMed2001

[A case of diaphragmatic paralysis in a patient with diabetes mellitus after surgery in prolonged prone position].

A 56-year-old woman with diabetes mellitus was scheduled for bilateral kidney lithotomy. She was in the prone position for about seven hours during operation. At the end of operation, arterial blood gas analysis showed PaO2 64 mmHg and PaCO2 44 mmHg under 100% oxygen inhalation through a face mask, and the chest x-rays showed elevation of the right diaphragm. Her trachea was intubated again. The right diaphragm returned to the preoperative level by positive pressure ventilation on supine position. Hypoxemia disappeared when the patient was placed in the sitting position, and the trachea was extubated. The right diaphragm returned to the normal level on the 1st postoperative day, but hypoxia continued until the 6th postoperative day with the patient on supine position. We speculate that the diaphragmatic paralysis was caused by over-extension of the neck for a prolonged period, and that the patient might have been susceptible to nerve injury due to underlying diabetes mellitus.

Diabetes Complications↗
PubMed1984

The prone position for CT of the lumbar spine.

In scanning the L5-S1 disk space, the known technical difficulty is limitation of the gantry angle. A prone scanning technique used to examine the lumbar spine may help to overcome or lessen this problem. A prospective CT scanning of the L5-S1 level was performed in both the prone and supine positions on 25 patients who had low back pain and who had not undergone previous laminectomy or fusion. The angle between the S1 vertebral end plate and maximum tilted gantry line (15 degrees on the G.E. 8800) was measured in the supine position and compared with the same angle in the prone position. In 20 of 25 cases (80%), significant improvement in alignment was noted in the prone position. The prone scanning technique is also more desirable if CT is performed with metrizamide. Finally, printed images from the prone technique allow easier image-patient orientation for viewing in the operating room.

Back Pain↗
PubMed2002

A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome.

OBJECTIVES: To evaluate of the oxygenation effects of 12-h prone positioning (PP) in ARDS patients and to assess the safety of such a procedure. DESIGN AND SETTING: Prospective observational study in a medical intensive care unit (12 beds) of a university hospital. PATIENTS: 51 consecutive ARDS patients. INTERVENTION: PP for at least 12 h daily until recovery or death. MEASUREMENTS AND RESULTS: Arterial blood gases were collected before and during PP and 1 h after return to supine. Turning adverse events, cutaneous bedsores, and enteral nutrition intolerance were specifically monitored and collected daily by a referring physician. In total 224 PP sessions were performed. Oxygenation improved 1 h after the turn and continued improving over the 12-h period (4). The beneficial effect persisted 1 h after return to supine (01). We considered 96% patients responders: 45% as early responders and 53% persistent responders (persistent benefit after return to supine). Four significant adverse events occurred during the 448 turning maneuvers (0.9%). Stage III ulceration and stage IV necrosis cutaneous bedsores occurred in ten patients (20%). Enteral nutrition intolerance was reported in 25% but without inability to meet patient's caloric requirement. CONCLUSIONS: Twelve-hour PP is a safe procedure and allows a continuous oxygenation improvement throughout the entire session.

Blood Gas Analysis↗
PubMed2002

Prone-position ventilation induces sustained improvement in oxygenation in patients with acute respiratory distress syndrome who have a large shunt.

OBJECTIVES: Prone-position ventilation (PPV) induces acute improvement in oxygenation in many patients with acute respiratory distress syndrome (ARDS), with some maintaining their oxygenation even after they were returned to the supine position, but it is unclear what clinical factors determine the sustained oxygenation benefit. We hypothesized that patients with ARDS who have a larger shunt would have a better acute and sustained oxygenation response to PPV. DESIGN: Prospective, nonrandomized interventional study. SETTING: Medical and surgical intensive care units, university tertiary care center. PATIENTS: Twenty-two consecutive patients, with ARDS with an average PaO2/FiO2 of 94, were administered PPV for 12 hrs followed by supine-position ventilation for 2 hrs. MEASUREMENTS: Hemodynamic and gas exchange variables were monitored. The shunt was measured as venous admixture at an FiO2 of 1.0, and compliances of the respiratory system, lung, and chest wall were measured by the esophageal balloon technique before PPV, during PPV, and during subsequent supine-position ventilation. MAIN RESULTS: Fourteen patients (64%) responded to PPV, with PaO2/FiO2 increasing by > or =20. These changes were associated with a decrease in chest wall compliance. Responders had significantly shorter time from ARDS to PPV, a lower baseline PaO2/FiO2, and a higher venous admixture. All responders maintained the improvement in oxygenation and had a greater respiratory system compliance after returning to the supine position. Time from ARDS to PPV and baseline lung injury score were negatively associated, whereas chest wall compliance, heart rate, and PaCO2 were positively associated with sustained improvement in oxygenation. CONCLUSIONS: PPV induced acute and sustained improvement in oxygenation in many patients with ARDS. The sustained improvement is more significant if PPV is administered early to patients with a larger shunt and a more compliant chest wall. Measuring venous admixture and chest wall compliance before PPV may help select a subgroup of patients with ARDS who may benefit the most from PPV.

Adult↗
PubMed2005

High-frequency oscillatory ventilation and adjunctive therapies: inhaled nitric oxide and prone positioning.

OBJECTIVE: To review the use of high-frequency oscillatory ventilation (HFOV) with adjunctive therapies (inhaled nitric oxide [iNO] and prone positioning [PP]) in adult patients with acute respiratory distress syndrome (ARDS). DATA SOURCES: Published studies evaluating the use of iNO, PP, and HFOV in adult patients with ARDS. DATA SUMMARY: Despite ongoing preclinical and clinical research, the therapeutic armamentarium for ARDS remains limited. Although a pressure- and volume-limited strategy aimed at mitigating ventilator-associated lung injury has demonstrated mortality benefit, patients with severe ARDS may still develop life-threatening hypoxemia. As a result, various salvage therapies aimed at improving oxygenation, including HFOV, iNO, and PP alone or in combination, have been evaluated in patients with refractory ARDS. Although the few preclinical and clinical trials of combination therapy to date have shown promising improvements in oxygenation and other physiological variables, with few adverse clinical events, the impact on survival awaits the performance of large randomized trials. CONCLUSIONS: There is limited clinical data to recommend the widespread use of combination therapy in patients with ARDS. In the subset of patients with life-threatening hypoxemia from refractory ARDS, combination therapy is safe and may be considered for salvage therapy. More rigorous randomized, controlled trials are needed to help delineate the therapeutic role of combination therapy in adults with ARDS.

Administration, Inhalation↗
PubMed2005

Short-term effects of prone position in chronic obstructive pulmonary disease patients with severe acute hypoxemic and hypercapnic respiratory failure.

OBJECTIVE: To assess the short-term effects of prone positioning (PP) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxemic and hypercapnic respiratory failure requiring invasive mechanical ventilation. DESIGN AND SETTING: Prospective observational study in the general intensive care unit of a university-affiliated hospital. PATIENTS: 11 consecutive COPD patients with persistent hypoxemia (PaO2/FIO2 < or = 200 mmHg with FIO2 > or = 0.6) and hypercapnia requiring invasive mechanical ventilation. Patients with adult respiratory distress syndrome or left ventricular failure were excluded. Mean age was 73+/-11 years, mean weight 86+/-31 kg, mean SAPS II 53+/-10, and ICU mortality 36%. INTERVENTIONS: Patients were turned every 6 h. MEASUREMENTS AND RESULTS: A response to PP (20% or greater PaO2/FIO2 increase) was noted in 9 (83%) patients. Blood gases were measured in the PP and supine (SP) positions 3 h after each turn, for 36 h, yielding six measurement sets (SP1, PP1, SP2, PP2, SP3, and PP3). PaO2/FIO2 was significantly better in PP: 190+/-26 vs. 113+/-9 mmHg for PP1/SP1, 175+/-22 vs. 135+/-16 mmHg for PP2/SP2, and 199+/-24 vs. 151+/-13 mmHg for PP3/SP3. After PP1 PaO2/FIO2 remained significantly improved, and the PaO2/FIO2 improvement from SP1 to SP2 was linearly related to PaO2/FIO2 during PP1 (r=0.8). The tracheal aspirate volume improved significantly from SP1 to PP1. PaCO2 was not significantly affected by position. CONCLUSIONS: PP was effective in treating severe hypoxemia in COPD patients. The first turn in PP was associated with increased tracheal aspirate.

Aged↗
PubMedDate not supplied

Deleterious effects of the prone position in the full-term infant throughout the first year of life.

Seventy-one first-born infants who had been nursed in prone position since birth, were referred for motor assessment at 3 months, 5 months and 9 months. All infants were administered the same checklist of motor items, based on the Amiel-Tison Infant Neurological Evaluation and on the Brunet-Lézine Developmental Psychomotor Scale. Abnormalities in muscular shortening and delay in motor skills were found. These findings are critical as regards environmental influences on postural development, continuities in motor development and issues of early primary prevention. Early identification and follow-up programmes, including frequent changes in posture, are suggested in order to avoid abnormalities of motor behaviour and subsequently in postural patterns.

Cohort Studies↗