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PubMedDate not supplied

[Effects of ventilation of the lungs in prone position on the pulmonary oxygenation function and hemodynamic parameters of heart surgery patients with respiratory insufficiency in the postoperative period].

Effect of ventilation in the face-down position (VFDP) on the oxygenation function of the lungs and hemodynamics is studied in 32 patients (aged 22-64 years) subjected to open-heart surgery complicated by development of acute respiratory failure (RF). In 23 patients with grave respiratory distress syndrome, VFDP was performed with forced ventilation of the lungs (FVL) and in 9 with less grave RF, with noninvasive mask ventilation of the lung (NIMVL). Body position of patients on FVL was changed every 4-12 h, of nonintubated patients, 45-60 min. The oxygenation function of the lungs improved in the intubated patients as early as during the first hour of FVL in the face-down position: PaO2/FiO2 notably increased and a tendency to decrease of A-aDO2 and Qs/Qt was observed. The positive effect was maximal after at least 4-hour FVP in the face-down position: PaO2/FiO2 increased by 76.6%, intrapulmonary shunting fraction decreased by 43%, and the O2 alveolar-arterial difference decreased by 27% in comparison with the initial values. After body position of patients was changed, the above improvements did not disappear, despite a slight decrease of the effect attained. VFDP with NIMVL led to similar results: O2 alveolar-arterial gradient decreased, PaO2/FiO2 decreased by 24.2%, the mean values of this ratio approaching the norm. Positive effect somewhat decreased after catecholamines were discontinued, but the oxygenation function of the lungs remained better than initially.

Adult↗
PubMed1993

[Fiberoptic intubation in the prone position. Anesthesia in a thoraco-abdominal knife stab wound].

An ambulance was dispatched to a 40-year-old man with a stab wound. On arrival, the emergency physician found the patient lying face down with a large knife protruding from his back between the scapula and spinal column (Fig. 1). The vital signs were stable (blood pressure 120/70 mmHg, heart rate 90 min, respiratory rate 25-30 min, oxygen saturation 94%); the estimated blood loss was 500 ml. Oxygen was administered and two i.v. lines were inserted. After light sedation (diazepam), the patient was transported to the clinic in the face-down position. X-ray films and physical examination showed that the knife, with a length of about 30 cm, had penetrated 15 cm into the thorax; the tip was located at the diaphragm (Fig. 2). Endotracheal intubation for the surgical revision was performed with the patient in the face-down position: after topical anaesthesia of the nasal mucosa (cocaine), a fiberoptic device was introduced. Additional topical anaesthetic (lignocaine) was applied through the biopsy channel onto the mucosa of the larynx and pharynx. After a sufficient waiting period, the endotracheal tube was pushed over the fiberoptic device into the trachea without problems (Fig. 3). During the entire period the patient was awake and breathing spontaneously; no coughing or change of body position occurred. After correct placement of the tube, general anaesthesia was induced. During positioning of the patient in the operating theatre, the knife was unintentionally dislodged and critical bleeding occurred. The situation could be controlled by immediate transfusions and rapid surgical revision, which revealed injuries to the lung, diaphragm, and stomach. The patient recovered without severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2002

Lateral medullary syndrome after prone position for general surgery.

IMPLICATIONS: We describe postoperative lateral medullary syndrome with myoclonic spasm. Improper head rotation during positioning in the anesthetized patient might obstruct the flow of the vertebral artery at the neck and result in diminished perfusion of the associated regions in patients with a history of cervical spinal trauma.

Adult↗
PubMed2002

Effects of prone position ventilation in ARDS. An evidence-based review of the literature.

In summary, the many studies done on PPV show that the technique improves oxygenation most of the time. The mechanisms behind this effect are probably numerous and have yet to be elucidated completely. In addition, PPV is a safe procedure that rarely worsens a patient's respiratory status or causes other complications and is thus a welcome additional therapeutic option when treating patients with ARDS. Despite the recent large, randomized, controlled trial showing no improvement in mortality rate or organ dysfunction overall, there is evidence suggesting that PPV may be of most benefit in more severely ill patients. Further studies will be useful.

Adolescent↗
PubMed1999

[Splenic rupture as a complication of ventilation in the prone position and pneumococcal sepsis as a late complication].

We are reporting the case of a female patient who had to undergo splenectomy after she suffered splenic rupture as a result from "kinetic therapy" during the treatment for pulmonary failure secondary to sepsis. Four years later the patient was again admitted with a clinical picture consistent with sepsis. Two blood cultures were positive for pneumococci confirming the diagnosis of pneumococcal sepsis. This paper discusses the potential risks of kinetic therapy in patients with ARDS. After splenectomy there is increased risk of infection with certain bacteria, funghi, viruses and protozoa. The most common bacterial pathogen is pneumococcus. A polyvalent vaccine is available for prophylaxis. Although penicillin G is still commonly used as an antibiotic therapy for pneumococcal infection, increased resistance of pathogens to penicillin must be anticipated. Alternative antibiotic regimens are demonstrated.

Female↗
PubMed1996

Is the acquisition of a separate view of the sacroiliac joints in the prone position justified in patients with back pain?

One hundred consecutive patients in whom radiographs of the sacroiliac joints had been requested concurrently with radiographs of the lumbar spine and/or pelvis were reviewed to ascertain the diagnostic value of the sacroiliac radiograph. In 92 patients, radiographs of the lumbar spine or pelvis provided complete visualization of the sacroiliac joints, 81 of which were judged normal, six abnormal, and five equivocal. Review of the specific sacroiliac radiographs confirmed the six abnormal cases, and resulted in one equivocal case being judged abnormal. In no case did the sacroiliac joint radiograph result in a normal diagnosis being changed to abnormal. Where the sacroiliac joints appear normal on a lumbar spine or pelvic radiograph, there is no diagnostic benefit, and a considerable radiation penalty, from the performance of additional radiographs specific to those joints.

Adolescent↗
PubMed2001

Abdominal muscle activity during the abdominal hollowing manoeuvre in the four point kneeling and prone positions.

This study investigated the pattern of recruitment of the abdominal muscles during the abdominal hollowing manoeuvre (AHM), in four point kneeling and prone. Muscle activity was detected and recorded by surface electromyography (EMG), in 20 healthy subjects, 8 male and 12 female, aged between 19 and 30 during both maximal activity, and the AHM. The degree of activation during hollowing was expressed as a percentage of maximal. There was activity in the internal abdominal oblique (IO) during all hollowing manoeuvres, in both starting positions, whilst only two subjects showed any activity in rectus abdominis (RA). Simultaneous activity in IO and EO occurred both in four point kneeling (45% of the subjects) and especially in prone (75% of the subjects). Across both positions IO activity was significantly greater than EO. There was no significant difference in EO or IO activity comparing across positions. These results suggest that the AHM when performed in four point kneeling and prone always activates IO and rarely activates RA, whilst elimination of activity in EO is more difficult to achieve, particularly in prone. Isolated activity in the deep abdominal muscles may not always be achievable in these starting positions.

Abdominal Muscles↗
PubMed2002

Comparison of sitting versus prone position for stereotactic large-core breast biopsy in surgically proven lesions.

OBJECTIVE: Our purpose was to compare the two different body positions for stereotactic large-core breast biopsy with regard to sensitivity, specificity, and accuracy, as well as complication rate. SUBJECTS AND METHODS: Two hundred patients had large-core breast biopsy performed either in the prone (n = 100) or in the sitting (n = 100) position and subsequently underwent surgical resection. The histopathologic findings of large-core breast biopsy and surgery of all 200 patients were compared; sensitivity, specificity, and accuracy were calculated for both groups. Biopsy-associated complications were prospectively recorded for immediate and delayed events and for technical failures in both groups. RESULTS: Sensitivity (96%), specificity (100%), and accuracy (98%) were the same for both groups with two false-negative findings in each group. The two false-negative results in the sitting group were caused by vasovagal reactions, whereas those in the prone group were caused by technical failure and uncomfortable biopsy position. More statistically significant complications (seven vs four, p < 0.001) and vasovagal reactions (seven vs two, p < 0.0001) were seen in the sitting group. CONCLUSION: For performance of large-core breast biopsy, both the prone and sitting positions are reliable and accurate methods. However, vasovagal reactions that could potentially complicate biopsy were seen significantly more often in the sitting position.

Adult↗
PubMed2002

Prone position as a life-saving measure for acute pulmonary haemorrhage in a young adult with cystic fibrosis.

Fatal pulmonary haemorrhage is a rare complication of cystic fibrosis. A case of unexpected life-threatening pulmonary haemorrhage is presented, and the successful management of this problem including immediate prone ventilation. Different anaesthetic techniques, avoiding endotracheal intubation and positive pressure ventilation, which may avoid similar complications, are described.

Acute Disease↗
PubMed1999

Influence of patient positioning on dose-volume histogram and normal tissue complication probability for small bowel and bladder in patients receiving pelvic irradiation: a prospective study using a 3D planning system and a radiobiological model.

PURPOSE: A prospective study was undertaken to evaluate the influence of patient positioning (prone position using a belly board vs. supine position) on the dose-volume histograms (DVHs) of organs of risk, and to analyze its possible clinical relevance using radiobiological models. METHODS AND MATERIALS: From November 1996 to August 1997 a computed tomography (CT) scan was done in the prone position using a belly board and in supine position in 20 consecutive patients receiving postoperative pelvic irradiation because of rectal cancer. Using a three-dimensional (3D) planning system (Helax, TMS) the DVH for small bowel, bladder, a standard planning target volume (PTV) of postoperative irradiation of rectal cancer, the intersection of volume of PTV and small bowel (PTV intersection V(SB), respectively, of PTV and bladder (PTV intersection V(B)) were defined in each axial CT slice. The normal tissue complication probability (NTCP) was determined by the radiobiological model of Lyman and Kutcher using the tolerance data of Emami. For evaluation of late toxicity alpha/beta ratio was 2.5; for evaluation of acute toxicity, it was 10. Total dose was 50.4 Gy (1.8 Gy/fraction) (ICRU 50). RESULTS: Using the prone position compared to the supine position, the median volume of PTV intersection V(B) was reduced by 18.5 cm3 (62%). Median dose (related to the reference dose) to the bladder was 44.5% (22.4 Gy) in prone and 66.05% (33.3 Gy) in supine position (p<0.001). Median V(B) within the 90% (45.4 Gy), 80% (40.3 Gy), 60% (30.2 Gy), and 40% (20.2 Gy) isodose was significantly lower in the prone position when compared to the supine position. Using the radiobiological models, however, there was no difference of NTCP between prone position or supine position. In the prone position, median volume of PTV intersection V(SB) was reduced by 32.5 cm3 (54%). The median dose to small bowel was 30.85% (15.4 Gy) in the prone position and 47.35% (23.9Gy) in the supine position (p<0.001). Significant differences between prone and supine position were found for median V(SB) within the 90% (45.4 Gy), 80% (40.3 Gy), 60% (30.2 Gy), and 40% (20.2 Gy) isodose. According to the method of Lyman, median NTCP of small bowel was significant lower in prone than in supine position. CONCLUSION: The prone position with a standard belly board should be the standard positioning technique for patients receiving adjuvant postoperative radiation therapy following surgery of rectal cancer. Both irradiated volume and total dose to the organs of risk can be reduced significantly. As a consequence of this, radiation induced toxicity will be minimized.

Adult↗