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Results for “Prone Position”

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PubMed2002

Topographical distribution of pulmonary perfusion and ventilation, assessed by PET in supine and prone humans.

Using positron emission tomography (PET) and intravenously injected (13)N(2), we assessed the topographical distribution of pulmonary perfusion (Q) and ventilation (V) in six healthy, spontaneously breathing subjects in the supine and prone position. In this technique, the intrapulmonary distribution of (13)N(2), measured during a short apnea, is proportional to regional Q. After resumption of breathing, regional specific alveolar V (sVA, ventilation per unit of alveolar gas volume) can be calculated from the tracer washout rate. The PET scanner imaged 15 contiguous, 6-mm-thick, slices of lung. Vertical gradients of Q and sVA were computed by linear regression, and spatial heterogeneity was assessed from the squared coefficient of variation (CV(2)). Both CV and CV were corrected for the estimated contribution of random imaging noise. We found that 1) both Q and V had vertical gradients favoring dependent lung regions, 2) vertical gradients were similar in the supine and prone position and explained, on average, 24% of Q heterogeneity and 8% of V heterogeneity, 3) CV was similar in the supine and prone position, and 4) CV was lower in the prone position. We conclude that, in recumbent, spontaneously breathing humans, 1) vertical gradients favoring dependent lung regions explain a significant fraction of heterogeneity, especially of Q, and 2) although Q does not seem to be systematically more homogeneous in the prone position, differences in individual behaviors may make the prone position advantageous, in terms of V-to-Q matching, in selected subjects.

Adult↗

PubMed1987

Gastro-oesophageal reflux in infants. Evaluation of treatment by pH monitoring.

Forty bottle-fed babies, 4-12 weeks old, with clinical gastro-oesophageal reflux were studied. Continuous 24 h oesophageal pH monitoring in a prone position demonstrated a gastro-oesophageal reflux with all of the following parameters: reflux index, duration of the longest reflux episode, number of reflux episodes in 24 h, number of reflux episodes greater than 5 min in 24 h. Positional therapy (prone-antitrendelenburg position), applied to all infants, resulted in a normalization of these parameters in ten of them. The remaining 30 infants were treated with milk-thickening agents, as recommended by Carre. Nearly all (N = 25) showed an important clinical improvement. A third pH monitoring was performed after 10-14 days of treatment. In six infants the results were completely within normal ranges. In 24 infants a decrease in the number of reflux episodes was demonstrated, with a comparable reflux index and number of long lasting reflux episodes. The duration of the longest reflux episode however increased significantly (P less than 0.001). Drugs (domperidone, Gaviscon) added to the milk-thickening agents in these 24 children, led to normalization of pH tracings. Clinical symptoms were less severe or disappeared in all infants but one. We conclude that if positional therapy (prone-antitrendelenburg) does not correct gastro-oesophageal reflux in infants, pharmacological treatment should be applied. Milk-thickening agents alone can be effective in individual cases but should be prescribed with care as they can lead to more occult gastro-oesophageal reflux with episodes of longer duration, increasing the risk of oesophagitis or respiratory distress.

Alginates↗

PubMed1994

Prone oblique positioning for computed tomographic arthrography of the shoulder.

Computed tomographic arthrography (CTA) of the shoulder is currently the best investigation of the unstable shoulder. 47 patients had CTA in the prone oblique position to assess its ability to demonstrate both anterior and posterior capsular mechanisms simultaneously. The first five patients were also scanned supine oblique to allow direct comparison with the prone oblique position. All studies were reviewed retrospectively by three musculoskeletal radiologists with regard to how well the relevant structures were demonstrated. In the prone oblique position, the anterior capsule was well shown in 98%, anterior labrum 98%, posterior capsule 91%, posterior labrum 89%, subscapularis tendon 98%, biceps tendon 100% and biceps tendon proximal insertion 78%. In 86% of cases both anterior and posterior structures were well seen simultaneously. In the five cases that also had supine imaging the prone oblique images were superior. The cause of poor demonstration of structures was invariably insufficient intraarticular air. It is concluded that the prone oblique is an excellent technique for CTA of the shoulder and should become the standard position for assessing shoulder instability.

Adolescent↗

PubMed1995

Vulnerability of respiratory control in healthy preterm infants placed supine.

OBJECTIVE: We tested the hypothesis that healthy preterm infants have attenuated ventilatory responses to hypercapnia, associated with a decreased rib cage contribution to ventilation, in the supine versus prone position. STUDY DESIGN: We elicited hypercapnic ventilatory responses from 19 healthy preterm infants (postconceptional age 35 +/- 1 weeks) who were being prepared for hospital discharge. The O2 saturation was continuously monitored. Before and during CO2 rebreathing, ventilation was measured with a nasal mask pneumotachygraph and was derived from chest wall motion as determined by respiratory inductance plethysmograph. This measuring method allowed us to compare both ventilation and the percentage rib cage contribution to ventilation between supine and prone positions. Statistical analysis employed analysis of variance with repeated measures. RESULTS: The supine position was associated with a higher respiratory rate (p < 0.02) and lower O2 saturation (p < 0.007) than the prone position. The increase in ventilation in response to hypercapnia was lower in the supine than in the prone position. This was statistically significant for the respiratory inductance plethysmograph (p < 0.008) but not the pneumotachygraph (p = 0.077), and was associated with a smaller rib cage contribution to ventilation in the supine than in the prone position (p < 0.0001). CONCLUSION: Respiratory control may be vulnerable when healthy preterm infants are placed supine. Widespread avoidance of the prone position may not be appropriate for such patients.

Carbon Dioxide↗

PubMed2004

Renal dimensions measured by ultrasonography in children: variations as a function of the imaging plane and patient position.

The purpose of this study was to determine the effect of patient positioning on sonographic renal measurements and to test if the patient position alters the three-dimensional shape of the kidneys. The maximum longitudinal renal length and transverse renal width and depth were measured in the supine and prone position in 100 children (200 kidneys). Age ranged from 6 months to 16 years (mean age 5 years). The results were compared for statistically significant differences. The maximum measured longitudinal renal length was statistically significantly larger in the supine than in the prone position (supine position, left: 8.0 cm; right: 7.7 cm; prone position, left: 7.9 cm, right: 7.6 cm; P<0.001). There was no statistically significant change in the transverse diameters (width and depth, P>0.001) and renal volume ( P>0.001) in the supine vs. prone positions. Our results show that position-induced reshaping of the kidneys is unlikely to be responsible for the discrepancy in maximum longitudinal renal measurements comparing supine with prone positions. Position-dependent changes in the degree of filling of the renal calyces and pelvis as well as errors in caliper distance measurements for the different scan depths (supine vs. prone) are more likely to be responsible for the encountered differences. Consequently, we recommend to add prone renal length measurements in addition to the supine measurements. In follow-up examinations, renal length measurements should only be compared that have been collected in the same patient position.

Adolescent↗

PubMed1992

Further evidence supporting a causal relationship between prone sleeping position and SIDS.

A 3 year case-control study identifying the risk factors for SIDS was undertaken. Preliminary analysis of the data from the first year suggested that SIDS mortality could fall by 50% if the prevalence of the prone sleeping position changed from 40 to 0%. During the 3 year study the prevalence of the prone sleeping position among infants has fallen from 43% in the first year to 20% in the third year. SIDS mortality has fallen to 3.1/1000 live births, which is very close to that predicted. When considered with other available evidence this strongly supports a causal relationship between the prone sleeping position and SIDS.

Case-Control Studies↗

PubMed1997

Temporal disparity between reduction of cot death and reduction of prone sleeping prevalence.

According to several reports sudden infant death rates have decreased significantly after public campaigns aimed at reducing the incidence of sleeping in a prone position. The Styrian population (1.2 million inhabitants), who have been studied from 1984, also showed a significant drop in the incidence of cot death during 1989 (from 2/1000 to 1/1000%). The year before, a campaign for the prevention of cot death had been launched. This included the recommendation to prevent infants from lying in a prone position during sleep. Part of the prevention programme consisted of a detailed questionnaire filled in and returned by the parents. These data, on 29970 infants from 1989 to 1994, provided information on the frequency of prone sleeping in 37% of our total population and as a consequence on parental response to the campaign. Calculating the data per year led to the surprising result that the reduction by half (from 50% to 25%) in the prevalence of sleeping in a prone position did not occur in 1989, when the drop in the incidence of cot death occurred, but 3 years later, in 1992. The following years saw a further decrease of prone position to 7% but no appreciable change in the incidence of cot death. However, during those 11 years of study about 80% of the victims were consistently found dead lying in a prone position. Our results show a temporal disparity between the reduction of sudden infant death and the decrease of prone sleeping in a population. Although we do not deny sleeping in a prone position as a risk factor for cot death, there cannot be a simple relationship between sleeping habits in the population and incidence of cot death.

Austria↗

PubMed1992

Spatial correlation of regional pulmonary perfusion.

Despite the heterogeneous distribution of pulmonary blood flow, perfusion appears to be spatially ordered, with neighboring regions of lung having similar magnitudes of flow. This premise was tested by determining the spatial correlation of regional flow [rho(d)] as a function of distance (d) between regions. Regional pulmonary perfusion was measured in both supine and prone positions in seven anesthetized mechanically ventilated dogs with radiolabeled microspheres. After excision and drying, the lungs were cubed into pieces 1.2 cm on a side, with a three-dimensional coordinate assigned to each piece. The microsphere-determined flow to each piece was measured by radioactive counts, and rho(d) was calculated for all paired pieces within the same lobe. rho(d) was greatest for adjacent pieces (d = 1.2 cm) and decreased with increasing d, becoming negative at large distances in all dogs and positions. The spatial correlation of flow between adjacent pieces, rho(1.2 cm), was greater in the supine than in the prone position (0.66 vs. 0.72, P less than 0.05). The observations for each dog and position were fit to the equation rho(d) = d(a)+b.d+c, and the coefficients were used to compare rho(d) in the supine and prone positions. rho(d) differed in the two positions (P less than 0.05), with rho(d) falling off more rapidly with distance in the supine position. When trends in flow due to gravity were mathematically removed, differences between supine and prone positions were no longer observed. The spatial correlation of regional pulmonary perfusion was anisotropic in both supine and prone positions. The observation that regional pulmonary perfusion is highly correlated over large spatial distances has important implications for models of flow distribution.

Animals↗

PubMed1992

Diagnosis of asphyxia on the sudden infant death--prone sleeping position and vomit aspiration.

An inevitable conclusion of studies in the Netherlands, Great Britain, the United States and Japan is that sudden infant death syndrome (SIDS) is intimately linked to the prone sleeping position of infants. But this cause of death cannot be explained by the conventional view of SIDS. Although asphyxia would be the most plausible explanation, the cause of death in the majority of SIDS-related deaths in Japan are ruled as SIDS, primarily because administrative autopsies in this country are delayed and the diagnosis is most often made from an external examination only. This lack of autopsy reports also hampers research in this area. Moreover, even where autopsies have been conducted, because of the lack of clear criteria for diagnosis, inconsistent rulings are rendered depending on the judgment of the presiding pathologist. Given these considerations, we undertook to examine the diagnostic criteria for death by asphyxiation among infants sleeping in the prone position, and the problems associated with such a diagnosis.

Asphyxia↗

PubMed1996

Supine approach to the sciatic nerve in the popliteal fossa.

PURPOSE: Sciatic nerve block in the popliteal fossa (popliteal nerve block, PNB) is an anaesthetic technique well-suited for operations below the knee. However, difficulty with positioning the patient in the prone position often precludes the classical, posterior approach to the block. In this report, an alternative approach to PNB that can easily be performed with a patient in the supine position is described. CLINICAL FEATURES: Three patients in whom the clinical circumstances precluded the use of the classical approach to PNB are described. In each case, PNB was performed using the alternative, supine approach. With a patient in the supine position, the leg is flexed at both the hip and knee, and supported by an assistant. After the anatomical landmarks of the popliteal fossa are identified, an insulated needle attached to a peripheral nerve stimulator is inserted 7 cm above the popliteal crease, 1 cm laterally to the midline and directed 45 degrees cephalad. Upon obtaining either dorsal or plantar flexion of the foot at the output current of 0.5 mAmp or less. 30-40 ml of local anaesthetic solution are injected. CONCLUSION: The supine approach to PNB allows the use of the block in patients that cannot be positioned in the prone position. Flexion of the leg at the knee greatly facilitates identification of the anatomical landmarks. When combined with a block of the femoral or saphenous nerve, this technique provides excellent anaesthesia for patients undergoing foot and ankle surgery.

Adult↗

PubMed2002

[ARDS and severe brain injury. Therapeutic strategies in conflict].

The development of adult respiratory distress syndrome (ARDS) complicates the treatment of patients with severe head injury, since special therapeutic strategies for both conditions might lead to a "conflict of interest". We report on the intensive care treatment of a young man who suffered severe brain injury (Glasgow Coma Scale = 3) due to a traffic accident and simultaneously developed ARDS from the aspiration of gastric content. We performed extensive monitoring of cerebral hemodynamics and metabolism (intracranial pressure measurement, jugular bulb oxymetry, estimation of arterial-jugular bulb lactate concentration difference) to prevent cerebral hypoxia and to control cerebral hyperemia. The application of a "lung protective strategy" with "permissive hypercapnia" led to a conflict, since the development of cranial hyperemia combined with cranial hypertension a few days after trauma, warranted the concept of controlled, temporary hyperventilation. Therefore, we applied a pumpless extracorporeal lung assist to improve carbon dioxide elimination. Furthermore, we started the ventilation in the prone position, since arterial oxygenation continued to deteriorate, although there is a lack of data describing the effect of a prone position on acute cerebral injury. Positioning the patient prone, we observed a prompt increase in intracranial pressure, which resulted in pharmacological intervention (mannitol). Treating the patient by intermittent prone position, by continuous extracorporeal lung assist and aerosolized prostacyclin administration in the following period, lung function improved and ARDS was treated successfully. After withdrawing the analgo-sedation the patient's vigilance rose continuously. The patient was transferred to a rehabilitation ward 33 days after admission to the intensive care unit. The combination of ARDS and severe brain injury needs special treatment, which includes extensive monitoring techniques to find a solution for therapeutic conflicts.

Adult↗

PubMed2005

Positioning for acute respiratory distress in hospitalised infants and children.

BACKGROUND: Because of the association between prone positioning and sudden infant death syndrome SIDS) it is recommended that young infants be placed on their backs (supine). However, the supine position might not be the most appropriate position for infants and children hospitalised with acute respiratory distress. Positioning patients has been proposed as a non-invasive way of increasing oxygenation in adult patients with acute respiratory distress. But, because of substantial differences in respiratory mechanics between adults and children and the risk of SIDS in young infants, a specific review of positioning for infants and young children with acute respiratory distress is warranted. OBJECTIVES: To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October Week 3, 2004); EMBASE (1980 to week 24, 2004); and CINAHL (1982 to October Week 3, 2004). SELECTION CRITERIA: All randomised or systematically-allocated controlled clinical trials comparing two or more positions in the management of infants and children hospitalised with acute respiratory distress. DATA COLLECTION AND ANALYSIS: Data were extracted from each study independently by two authors. Differences were resolved by consensus or referral to a third author. Continuous outcomes were analysed using a weighted mean difference and 95% confidence interval. No bivariate outcomes were available. All but one included study reported crossover data therefore this data was used for meta-analysis. Fixed-effect models were used unless heterogeneity was significant (p value equal to or less than 0.1), in which case a random-effects model was used. MAIN RESULTS: Forty-nine papers were selected for this review of which 21 studies (22 publications) were included. These studies compared prone, supine, lateral, elevated, and flat positions. Prone positioning was significantly more beneficial than supine positioning in terms of oxygen saturation, partial pressure of arterial oxygen, oxygenation index, thoraco-abdominal synchrony, and episodes of desaturation. There were no statistically significant differences between any other positions. AUTHORS' CONCLUSIONS: The prone position was significantly superior to the supine position in terms of oxygenation. However, as most patients included in the meta-analysis were ventilated, preterm infants the benefits of prone positioning may be most relevant to these infants. In addition, although placing infants and children in the prone position may improve respiratory function, the association of sudden infant death with prone positioning means that infants should only be placed in this position if continuous cardiorespiratory monitoring is used.

Adolescent↗

PubMed2000

A comparison of ventilatory prostate movement in four treatment positions.

PURPOSE: To ensure target coverage during radiotherapy, all sources of geometric uncertainty in target position must be considered. Movement of the prostate due to breathing has not traditionally been considered in prostate radiotherapy. The purpose of this study is to report the influence of patient orientation and immobilization on prostate movement due to breathing. METHODS AND MATERIALS: Four patients had radiopaque markers implanted in the prostate. Fluoroscopy was performed in four different positions: prone in alpha cradle, prone with an aquaplast mold, supine on a flat table, and supine with a false table under the buttocks. Fluoroscopic movies were videotaped and digitized. Frames were analyzed using 2D-alignment software to determine the extent of movement of the prostate markers and the skeleton for each position during normal and deep breathing. RESULTS: During normal breathing, maximal movement of the prostate markers was seen in the prone position (cranial-caudal [CC] range: 0.9-5.1 mm; anterior-posterior [AP] range: up to 3.5 mm). In the supine position, prostate movement during normal breathing was less than 1 mm in all directions. Deep breathing resulted in CC movements of 3.8-10.5 mm in the prone position (with and without an aquaplast mold). This range was reduced to 2.0-7.3 mm in the supine position and 0.5-2.1 mm with the use of the false table top. Deep breathing resulted in AP skeletal movements of 2.7-13.1 mm in the prone position, whereas AP skeletal movements in the supine position were negligible. CONCLUSION: Ventilatory movement of the prostate is substantial in the prone position and is reduced in the supine position. The potential for breathing to influence prostate movement, and thus the dose delivered to the prostate and normal tissues, should be considered when positioning and planning patients for conformal irradiation.

Adenocarcinoma↗

PubMed1992

An analysis of supraspinatus EMG activity and shoulder isometric force development.

Injury to the shoulder represents a significant disability to the athlete participating in throwing and other overhead sporting activities. There are few scientifically based rehabilitation protocols regarding the most efficient exercises for the rotator cuff musculature. There is contradiction concerning the most efficient position for supraspinatus muscle electromyographic (EMG) activity. Because the supraspinatus is the most frequently injured musculotendinous structure of the shoulder, the most efficient position for testing and rehabilitation of this structure should be identified. The purposes of this study were to compare two test positions for supraspinatus EMG activity and maximal voluntary isometric contraction (MVIC) force development of the shoulder. Twenty-two subjects performed MVIC in the two recommended testing positions. A paired t-test revealed the prone position produced significantly greater (P = 0.04) EMG activity than the standing test position. An additional paired t-test revealed the standing position produced significantly greater (P = 0.0001) force than the prone position. Since the supraspinatus EMG activity was lowest in the position that produced the greatest shoulder MVIC force, we hypothesize that muscle substitution occurred. We recommend the prone position for supraspinatus rehabilitation and testing.

Adult↗

PubMed1992

[The vertical component in a caloric nystagmus and the existence of a second phase of the nystagmus--the possibility of canal otolithic interaction in normal subjects].

To clarify the existence of the vertical component during a caloric nystagmus and the existence of a second phase of the nystagmus, 194 induced incidents of a caloric nystagmus in 29 normal subjects have been analyzed. Each nystagmus episode was recorded by using ENG and an infra-red video camera. The caloric stimuli were given by pouring 5 ml of water at 20 degrees C into the ear at an ear-up position. After irrigation, each subject then assumed a supine or a prone position, with the head bent 30 degrees forward in either position. All recordings contained vertical components that depended on the supine or prone head position and not on the side of the stimulated ear, i.e., an up-beating nystagmus resulted in the supine position and a down-beating nystagmus in the prone position. Further, the vertical component was far stronger in the prone position. In contrast, the horizontal component had larger velocities and was of longer duration in the supine position than in the prone position. When the first phase of the caloric nystagmus ended, the body position was changed 90 degrees, i.e., to a sitting position or a right-ear-down or left-ear-down position. All trials showed a horizontal component during the secondary phase when the head assumed the sitting position. As for the ear-down positions, only when the irrigated ear was moved upwards from the prone position during the secondary phase, an up-beating vertical nystagmus resulted in almost all the trials. These findings suggest that a caloric nystagmus may originate not only from the lateral semicircular canal but also from the vertical canals, and the second phase of a caloric nystagmus may be strongly influenced by the otolithic organs.

Electronystagmography↗

PubMed1995

Effect of body position on the blood gases and ventilation volume of infants with chronic lung disease before and after feeding.

The effect of body position before and after tube feeding was evaluated in six extremely immature infants who were being mechanically ventilated because of chronic lung disease. Their mean birthweight and gestational age were 722.7 g (range, 540 to 994) and 24.9 weeks (range, 23.9 to 26.0), respectively. This study was performed at a mean postnatal age of 47.5 days (range, 21 to 85 days). The prone position resulted in a significant increase in arterial oxygen saturation before and after feeding, whereas the tidal volume demonstrated an increase only before feeding. Also the prone position showed a significant decrease in heart rate before and after feeding and a tendency to decrease transcutaneous carbon dioxide tension values before feeding. There were no significant differences in minute ventilation despite increased tidal volume in the prone position, most likely due to a decrement of the spontaneous respiratory rate in the prone positioning. We conclude that the prone position may offer an advantage over the supine position in the management of extremely immature infants with chronic lung disease before and after feeding.

Carbon Dioxide↗

PubMed2006

The amplitude of the Achilles tendon reflex in infants is related to body position.

In this study, we investigated whether the Achilles tendon reflex (ATR) in healthy infants is modulated by changes in body position (prone vs. supine). The amplitude of the ATR was compared at postnatal day 1, months 2, 3 and 6, while infants were placed in prone and supine position. The ATR was considered "positive" when at least 1 of 20 tendon taps evoked a visible contraction of the ankle plantar flexor muscles. At 6 months, the amplitude and latency of the ATR were evaluated by electromyographic (EMG) recordings of the (lateral and medial) gastrocnemius muscle, with the infant in prone and supine position. At postnatal day 1, the clinical ATR response was more frequently present in prone than supine position (14/16 or 88% vs. 4/16 or 25%, respectively, p < 0.01). From 2 months onwards, the frequencies of positive ATRs were no longer significantly different between prone (14/14 or 100%) and supine position (10/14 or 67%). However, based on the EMG recordings at 6 months, the ATR amplitude was higher in prone compared to supine position (n=8, median 5.5 mV, range 4.7-6.6 mV; and median 3.8 mV, range 2.3-5.6 mV, p < 0.05). We conclude that the ATR response in healthy infants is more pronounced in prone than in supine position, either when clinically (visually) assessed during routine tendon tapping or when neurophysiologically assessed during surface EMG recording.

Achilles Tendon↗

PubMed1999

[Ethnic origin and care giving styles relevant to cot death].

OBJECTIVE: To examine whether ethnic origin is related to care giving styles relevant to sudden infant death. DESIGN: Prospective/retrospective, descriptive. METHOD: In six child health care centres in Amsterdam, the Netherlands, data about sleep position, bedclothes and passive smoking of infants aged 1-5 months were collected by face-to-face interviews of mothers visiting these centres between February 1997 and October 1998. RESULTS: Eligible for the study were 1815 infants, 919 boys and 896 girls, mean age 2 months. In Amsterdam 12.5% of infants were usually or sometimes put to sleep in a prone position, 31.0% usually or now and then in a side position (but not in a prone position) and 56.5% usually in a supine position. Prone sleeping position was more frequent among Surinamese infants and less frequent among Moroccan infants compared with Dutch infants. Overall use of a duvet among infants was 22.7%. Use of duvets was higher among allochtonous infants; after controlling for demographic factors this difference was not significant, however. 6.3% of the infants had slept in the previous night with a pillow. Use of a pillow was much more frequent among allochtonous than among autochtonous infants: 13% versus 1.2%. Maternal daily smoking during pregnancy and daily smoking by mothers or others at home at time of interview was found in 15.1% and 25.8% of the infants respectively. Almost no Moroccan mothers smoked during pregnancy (0.4%), while Turkish mothers smoked as much as Dutch mothers (18.5% and 21.6% respectively). No differences in daily smoking at home were found between Surinamese, Moroccan and Dutch families (circa 26%). However, daily smoking at home was much more frequent in Turkish families (43.8%). CONCLUSION: Health education about a safe sleeping position, about safe bedclothes and about the dangers of passive smoking is still needed. Education programmes to prevent sudden infant death must take into account ethnic differences in care giving styles. Special attention must be paid to the use of a pillow among allochtonous infants.

Adult↗