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Results for “Prone Position”

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PubMed1992

[Significance of sleeping position on the occurrence of sudden, unexplained infant death. An epidemiological review].

The cause of the sudden infant death syndrome (SIDS) is, according to the definition, unknown. Epidemiological research during recent years has identified a series of probable risk factors. One of these is the use of prone position as sleeping position. In the Western European countries, Australia and New Zealand, a total of 14 case-control studies illustrate a possible connection between the prone position and SIDS. Eleven of the studies revealed a significantly increased relative risk (RR) of between 1.4 and 12.5 for SIDS when using the prone position, while the three remaining studies did not demonstrate increased RR. A meta-analysis of the results of the 14 case-control studies showed an RR of 2.4 for SIDS in the prone position as compared with other sleeping positions. In a single prospective cohort study from Australia, an RR of 3.1 was found for SIDS in the prone position. Interventions in which parents are advised not to place the infants in the prone position during sleep appear to have resulted in considerable reduction in the number of cases of SIDS according to preliminary reports from Great Britain, the Netherlands, Norway and New Zealand. A series of methodological problems can be demonstrated in the published results of these studies, including limited size of study populations, inadequate matching of control groups and absent confounder control. Nevertheless, the total epidemiological evidence, also where Denmark is concerned, speaks in favour of altered recommendations for sleeping positions of infants, particularly because there is no documentation to suggest that the prone position offers any advantages to health.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗

PubMed1987

Effect of body position on later postural and functional lateralities of preterm infants.

The effects of body position during the neonatal period on subsequent functional and postural behaviours were examined in relatively low-risk preterm infants. 44 infants were nursed in the supine position and 37 in a prone position throughout their admission period. Persistent head-turning to the right was observed more often and continued longer in the infants lying in supine. Asymmetrical postures, e.g. of skull and trunk, were more often seen in infants lying in supine than in prone. The prone position was thought to help prevent infantile scoliosis. At nine months, preference for the right hand was more marked in infants lying in supine, whereas infants lying in prone used their hands bilaterally, a tendency that persisted at 18 months. Asymmetrical gait pattern with mild gait disturbance was found more often in infants lying in supine than in prone. The prone position was thought to prevent asymmetrical posture and excessive functional asymmetries.

Child Development↗

PubMed1996

Intraocular tamponade duration and success of macular hole surgery.

PURPOSE: The authors compare the success of macular hole surgery with a short duration tamponade using 5% perfluoropropane (C3F8), intermediate duration tamponade using 10% C3F8, or a long duration tamponade using 16% C3F8 in a prospective consecutive clinical trial at two institutions. METHODS: Vitrectomy and fluid-gas exchange was performed in 29 eyes treated with 5% C3F8 and 1 week of prone positioning, 30 eyes treated with 10% C3F8 and 2 weeks of prone positioning, and 90 eyes treated with 16% C3F8 and 2 weeks of prone positioning 90% of time, followed by 2 weeks of prone positioning 50% of time. RESULTS: The macular hole was closed successfully in 19 of 29 eyes (65.6%) treated with 5% C3F8, 19 of 30 eyes (63.3%) treated with 10% C3F8, and 85 of 90 eyes (94.4%) treated with 16% C3F8 at 3 months (P = 0.00017 for 5% vs. 16% C3F8, P = 0.00006 for 10% vs. 16% C3F8). The visual acuity improvements measured by refraction using the Early Treatment Diabetic Retinopathy Study (ETDRS) acuity charts paralleled the success of macular hole closure. The acuity improved a mean improvement of + 9.6 ETDRS letters for eyes treated with 5% C3F8, + 6.4 ETDRS letters for eyes treated with 10% C3F8, and + 13.1 ETDRS letters in eyes treated in 16% C3F8. CONCLUSIONS: A long duration intraocular gas tamponade with 16% C3F8 gives a substantially higher success rate for macular hole surgery than a short (5% C3F8) or intermediate duration (10% C3F8) intraocular gas tamponade.

Adult↗

PubMed1981

Duration and quality of the prone extension position in four-, six-, and eight-year-old normal children.

This study was designed to determine whether developmental changes occur in the duration and quality of maintaining a prone extension position. Three groups of 26 to 30 normal children ages 4, 6, and 8 years were tested on the prone extension position. Results indicated a significant difference in both duration of maintenance and quality between the performance of the four-year-olds and the other two age groups. No significant differences were found between the six- and eight-year-olds. Smooth assumption of the position and distance of thighs off the mat were found to be the most important factors in discriminating a good prone extension position from an inadequate one. The variability of performance by the four-year-olds indicates that the ability to assume and maintain a prone extension position is not a valid measurement tool for discriminating between normal children and those "at risk" for learning disabilities at this age level. The inability of children six years or older to maintain a "good" prone extension position for 30 seconds suggests a vestibular processing inefficiency.

Aging↗

PubMed1997

[Prone sleeping position and other risk factors in sudden infant death syndrome: a prevalence study in Geneva].

A survey by telephone interviews has been carried out in 1993 in the canton of Geneva, in order to measure the prevalence of 3 risk factors for the sudden infant death syndrome (SIDS) and to evaluate the potential for SIDS prevention based on these factors: prone sleeping position, tobacco smoking by the parents during pregnancy, and no complete breast-feeding at 8 days of age. 278 families participated to the study, of 320 families who could be contacted by telephone in Geneva, from a random sample of 550 families having had a child in Geneva in the preceding 12 months. 40% of the infants had been put to bed in the prone position on the preceding evening 18% of the mothers had smoked during pregnancy. Prevalence of low birth weight was 4.9% for 0 to 4 cigarettes per day during pregnancy, 17.2% for 5 cigarettes and more. At one week, 16.5% of children were not exclusively breast-fed. On the basis of these results, it can be estimated that an effective prevention programme, centered on prone sleeping position could decrease the incidence of SIDS by 50% or more. An even greater fraction of cases, up to 80%, could be avoided by the prevention of the 3 studied factors. These estimates show the need to develop a mother and child health programme in Switzerland.

Adult↗

PubMed1995

Play position is influenced by knowledge of SIDS sleep position recommendations.

OBJECTIVE: This study determined whether knowledge of sleeping in the prone position as a risk factor for sudden infant death syndrome (SIDS) influences caregivers' positioning of their infants for play and sleep. METHODOLOGY: One hundred caregivers attending Adelaide metropolitan Child Adolescent and Family Health Services (CAFHS) were surveyed by self-administered questionnaire. RESULTS: Ninety-three per cent of parents reported that their knowledge of SIDS influenced infant positioning for sleep and 84% reported they never put their infant in the prone position for sleep. Thirty-seven per cent reported that SIDS knowledge did influence play positioning and 26% reported never placing their infant prone for play. There was a significant association (P = 0.002) between the influence of SIDS knowledge on play positioning and avoidance of the prone position for play. CONCLUSIONS: Community educators may need to clarify that prone positioning for play is not a risk factor for SIDS and that it is desirable for infants to spend supervised wakeful time in the prone position.

Adult↗

PubMed1994

Thoracoscopic subtotal oesophagectomy.

A technique for endoscopic-assisted oesophagectomy is described using either a lateral or prone position for the oesophageal dissection. In a consecutive series of 34 patients, two were found to have hepatic deposits at preliminary laparoscopy, and four were inoperable at thoracoscopic staging. A further two had fibrous obliteration of the pleural cavity. Of the 26 procedures, 20 were performed in the lateral position and six in the prone position. There was one conversion to open thoracotomy due to massive aortic bleeding. There were no deaths. Postoperative complications included pneumonia (n = 3), recurrent laryngeal nerve palsy (n = 2) and one anastomotic leak. The median postoperative stay was 12 days (range 9-30 days). It is suggested that the prone position has technical advantages and reduces the postoperative respiratory complications.

Esophageal Neoplasms↗

PubMed2004

[Evaluation of the vocal tract during Japanese vowel production in myasthenia gravis using magnetic resonance imaging].

We report a 65-year-old Japanese female whose primary symptom of myasthenia gravis was related to rhinolalia aperta. The vocal tract during vowel production was evaluated using two-dimensional fast advanced spin echo (2D-FASE) MR images on supine and prone position. Before treatment, MRI on prone position demonstrated anterior shift of the palatine uvula and the tongue during Japanese "a", "u" and "o" production following the gravity, the former suggested the paresis of the sphenosalpingostaphylinus and elevator veli palatini muscle and the latter the paresis of the styloglossal and hypoglossal muscles. After treatment of steroid pulse and immune absorption, 2D-FASE images on prone position revealed the normalized configuration of the tongue and the soft palate during the Japanese five-vowel production. Kinetic MRI may be useful for evaluation of dynamics of the tongue and the soft palate.

Evaluation Studies as Topic↗

PubMed1995

The contribution of changes in the prevalence of prone sleeping position to the decline in sudden infant death syndrome in Tasmania.

OBJECTIVE: To determine the independent contribution of changes in infant sleep position to the recent decline in sudden infant death syndrome (SIDS) rate in Tasmania. DESIGN: (1) A comparison of the whole population incidence of SIDS before and after an intervention to reduce the prevalence of prone sleeping position. (2) A within-cohort analysis of the contribution of sleep position and other exposures to the decline in SIDS after the intervention. SETTING: Tasmania, Australia. PARTICIPANTS: (1) All SIDS cases from 1975 through 1992. (2) A sample of one in five infants born in Tasmania who at perinatal assessment were scored to be at higher risk for SIDS since January 1988. Of 5534 infants included in the study, 39 later died of SIDS. INTERVENTIONS: Multiple public health activities to reduce the prevalence of the prone infant sleeping position in Tasmania and verbal information on the association between prone position and SIDS to cohort participants from May 1, 1991. MAIN OUTCOME MEASURE: Sudden infant death syndrome incidence. RESULTS: The Tasmanian SIDS rate decreased (P < .01) from 3.8 (95% confidence interval [CI], 3.5 to 4.2) deaths per 1000 live births from 1975 through 1990 to a rate of 1.5 (95% CI, 0.9 to 2.2) deaths per 1000 live births in 1991 through 1992. The SIDS mortality rate in the cohort by period of birth was 7.6 (95% CI, 4.9 to 10.3) deaths per 1000 live births for those born from May 1, 1988, through April 30, 1991, and 4.1 (95% CI, 1.3 to 7.0) deaths per 1000 infants for those born from May 1, 1991, through October 31, 1992. The prevalence of usual prone sleeping position at 1 month of age was 29.9% and 4.3% in these two cohorts, respectively (adjusted odds ratio, 0.11; 95% CI, 0.08 to 0.13). Logistic regression demonstrated that 70% of the SIDS rate reduction in the cohort could be accounted for by the decreased prevalence of the prone sleeping position. Other factors examined individually contributed to less than 10% of the SIDS rate reduction. CONCLUSIONS: The major contributing factor to the recent SIDS rate decline in Tasmania has been the reduction in the proportion of infants usually sleeping prone.

Cohort Studies↗

PubMed1997

The prone-oblique surgical position.

The prone-oblique surgical position as introduced and used by Dr. Malis at Mount Sinai Hospital is presented. The advantages of this position over the prone and knee-chest positions are noted. Recommendations for the safe use of the prone-oblique position are made.

Female↗

PubMed1995

[Intermittent dorso-ventral positioning in therapy of severe post-traumatic lung failure].

The influence of intermittent prone positioning on pulmonary gas exchange and parenchymal densities was investigated in ten patients. Three patients fulfilled the criteria of "severe ARDS"; seven patients had moderate lung injury as documented by the "lung injury score" (LIS). Nine out of ten were trauma patients and had an average injury severity score of 32.3. The oxygenation index (paO2/FiO2) improved in all patients after prone positioning, showing an increase of 81 +/- 47 (20-197) mmHg (MV +/- SD). Total static lung compliance showed an increase of 7.6 (0-16) ml/mbar. Patients with ARDS benefitted especially from intermittent prone positioning, resulting in a substantial improvement of the LIS of 0.91 (0.75-1.0) points. In moderate lung injury the LIS improved 0.5 (0.25-1.0) points. In lung computerized tomography, we observed the disappearance of posterobasal densities. Repeated prone positioning may therefore be used in ARDS patients as well as in patients with moderate lung injury.

Adolescent↗

PubMed2002

Study of patient positioning on a dynamic frame for scoliosis surgery.

The goal of this clinical trial was to measure patient geometry on a dynamic positioning frame in various prone positions. Fourteen subjects (2 males and 12 females) were recruited from the scoliosis clinic at Ste-Justine Hospital on a volunteer basis. The subjects were AIS patients who were potential candidates for surgery. The Cobb angle, averaged 50 degrees (32 degrees-64 degrees). The mean age was 14.1 years (11-17). A Polaris system (Northern Digital inc, Canada) with 10 passive reflective markers was used to measure various indices of the patient's trunk geometry. Acquisitions were made while the unanaesthetized patient was in five different prone positions: I similar to the standard positioning on a Relton-Hall frame; II addition of a force applied to the ribcage at the apex of the curve; III application of a force at the apex of the curve in the lumbar region; IV, the shoulder pads were elevated to increase the patient's kyphosis; V adjustment of each pad and the application of thoracic and lumbar forces to obtain an optimal correction. The measurements of trunk geometry at each position were compared using position I as a base. A paired student t-test determined a significant difference between positions. When comparing position I to position II there was a significant difference and correction of the rib hump. There was also a significant change in shoulder angle that resulted in over correction. Position III had a significantly negative change in the rib hump. During position IV, there was a measurable increase in kyphosis. During the optimal correction, position V, a significant increase in spine length was observed as well as a significant correction in rib hump and shoulder angle. Patient trunk geometry can be improved by the application of different forces on a dynamic positioning frame. Caution is necessary as over correction and unintended negative effects were observed. The optimal patient position has not yet been found and future studies are directed at determining this.

Adolescent↗

PubMed1995

The Tasmanian SIDS Case-Control Study: univariable and multivariable risk factor analysis.

A population-based retrospective case-control study has been conducted in Tasmania since October 1988. Study measurements pertained to the scene of death of last sleep, as well as a verbal questionnaire on relevant exposures. From 1 October 1988 to 1 October 1991, 62 cases of sudden infant death syndrome (SIDS) occurred. Case response rate for retrospective interviews was 94% (58/62). The initial control response rate was 84% (101/121). After stratification for maternal age and birthweight, there was no increase in risk associated with the usual side position (odds ratio [OR] 1.05 [0.27, 5.02]), compared with the supine position (OR 1.00, reference). The prone position was associated with increased risk [OR 5.70 (1.67, 25.58)], relative to the supine position. In the final multivariable model, predictors of SIDS in this study were usual prone position (P < 0.001), maternal smoking (P = 0.008), a family history of asthma (P = 0.045) and bedroom heating during last sleep (P = 0.039). Protective factors were maternal age over 25 years (P = 0.013) and more than one child health clinic attendance (P = 0.003). The results provide further support for current health education activities which aim to inform parents of modifiable risk factors for SIDS, including the prone sleeping position, thermal stress and infant exposure to tobacco smoke.

Breast Feeding↗

PubMed2002

The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study.

BACKGROUND: Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality. OBJECTIVE: To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population. DESIGN, SETTING, AND POPULATION: Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS. MAIN OUTCOME MEASURES: Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity. RESULTS: Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6-3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8-8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2-2.6 and OR: 10.3, 95% CI: 10.3 [3.2-33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers. CONCLUSIONS: Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.

Adolescent↗

PubMed1994

Placement of a multiorificed catheter in the inferior portion of the right atrium; percentage of gas retrieved and success rate of resuscitation after venous air embolism in prone dogs positioned with the abdomen hanging freely.

Based on reports of fatal venous air embolism (VAE) occurring during lumbar laminectomy and spinal fusion in prone patients positioned with the abdomen hanging freely, it has been recommended that monitoring for VAE should be used for such cases, and that a multiorificed central venous catheter should be inserted for aspiration of VAE. A previous study from this laboratory reported that, in prone dogs positioned with the abdomen hanging freely, a multiorificed catheter located in the superior portion of the right atrium did not increase the success rate of resuscitation after VAE given via the femoral vein. The present study was designed to examine aspiration of VAE when prone dogs positioned with the abdomen hanging freely were given a fatal VAE via a femoral vein and a multiorificed catheter was located in the inferior portion of the right atrium. Fourteen dogs were anesthetized with isoflurane and nitrous oxide in oxygen and positioned with the abdomen ventral and hanging freely, the head fixed in a stereotaxic frame, the upper extremities resting on a surface approximately 10 cm below the level of the stereotaxic frame and the lower extremities on a surface below the level of the upper extremities (to assure that VAE entering the inferior vena cava would ascend toward the heart). In the control group (n = 7) a catheter was placed in the inferior portion of the right atrium but was not used to aspirate VAE. In a second group (n = 7) a modified Arrow prototype multiorificed catheter was inserted in the inferior portion of the right atrium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2005

Patient positioning and ventilator-associated pneumonia.

Rotational beds, prone position, and semi-recumbent position have been proposed as procedures to prevent ventilator-associated pneumonia (VAP). Rotational therapy uses a special bed designed to turn continuously, or nearly continuously, the patient from side to side; specific designs include kinetic therapy and continuous lateral rotation therapy. A meta-analysis of studies evaluating the effect of rotational bed therapy shows a decrease in the risk of pneumonia but no effect on mortality. Two studies reported a lower risk of VAP in patients placed in a prone position, with no effect on mortality. Studies using radiolabeled enteral feeding solutions in mechanically ventilated patients have reported that aspiration of gastric contents occurs to a greater degree when patients are in the supine position, compared with the semirecumbent position. One study reported a lower rate of VAP in patients randomized to semi-recumbent compared to supine position. Although each of the techniques discussed in this paper has been shown to reduce the risk of VAP, none has been shown to affect mortality. The available evidence suggests that semi-recumbent position should be used routinely, rotational therapy should be considered in selected patients, and prone position should not be used as a technique to reduce the risk of VAP.

Beds↗

PubMed2000

Complications of prone ventilation in patients with multisystem trauma with fulminant acute respiratory distress syndrome.

INTRODUCTION: Prone ventilation improves oxygenation in selected patients with acute respiratory distress syndrome (ARDS). However, prone positioning of critically ill patients with multiple invasive lines and tubes is potentially dangerous. Trauma patients, in particular, may require special consideration because of skeletal fixation devices or prior operative procedures. Our objective was to critically evaluate our experience with prone positioning in patients with severe postinjury ARDS. METHODS: Injured patients admitted to our Level I trauma center who developed ARDS were prospectively identified. Serial lung injury severity and pulmonary mechanical data, as well as complications of prone ventilation were recorded. RESULTS: During the 12-month period ending August of 1998, nine patients with postinjury ARDS were treated with prone ventilation because of hypoxemia refractory to other ventilatory strategies. All patients suffered blunt trauma. Their mean age was 29 +/- 4.5 years; seven patients were men. The average Injury Severity Score was 26 +/- 5; and, at the time of prone positioning, the mean Lung Injury Score was 3.5. The mean PaO2/FIO2 ratio increased from 75 +/- 7 to 147 +/- 27 with prone ventilation (p < 0.05, paired t test); and in six patients, the FIO2 could be decreased. Four major complications occurred (44%). One patient experienced a midline abdominal wound dehiscence. Severe facial or upper chest wall pressure necrosis developed in two patients, despite extensive padding and careful attention to skin care. The fourth patient sustained a cardiac arrest immediately after prone positioning. CONCLUSION: Prone ventilation in postinjury patients with ARDS may improve oxygenation but has the potential for significant complications. Careful consideration is required before prone positioning in this subset of patients.

Adult↗

PubMed1997

Technetium-99m-MIBI myocardial SPECT: supine versus right lateral imaging and comparison with coronary arteriography.

UNLABELLED: Myocardial perfusion SPECT using the prone position improves inferior wall counts and decreases motion problems as compared with the usual supine position. Nonetheless, it is not suitable for women. In addition, it is associated with artifactual anteroseptal defects and hot spots. METHODS: The right lateral (RL) position was evaluated instead of the prone position in 72 patients (26 women). RL imaging was performed immediately after the supine imaging during a routine 2-day 99mTc-sestamibi exercise protocol. The SPECT images were scored semiquantitatively by three physicians. Moreover, regional myocardial counts, as well as extent and severity of defects, were assessed by quantitative polar map analysis. RESULTS: All patients tolerated the RL position well and there was no significant patient movement in either position. Higher inferior myocardial counts per pixel were observed in the RL than in supine images. Inferior wall defects (especially mild ones) were more common in the supine than the RL images, whereas defects in other regions were not different. Quantitative analysis confirmed these findings. Analysis of 34 patients with recent coronary arteriography revealed an overall coronary artery disease (CAD) supine- and RL-imaging specificity of 50% and 75%, respectively, and the sensitivities of both were 93%. Right CAD sensitivity, specificity and normalcy rates for the supine position were 100%, 44% and 55%, whereas those of the RL position were 94%, 75% and 90%, respectively. CONCLUSION: The RL position improves CAD diagnostic accuracy, particularly right CAD, without significant artifacts in other myocardial regions. Unlike the prone position, the RL position is well tolerated by both women and men.

Artifacts↗