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Results for “Supine Position”

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PubMed1998

Effects of postural changes on left atrial function in patients with hypertrophic cardiomyopathy.

BACKGROUND: We assessed left atrial function in normal subjects and in patients with hypertrophic cardiomyopathy (HCM) by using Doppler echocardiography at the supine position and after sudden standing. METHODS AND RESULTS: Twenty-seven patients with hypertrophic obstructive cardiomyopathy (HOCM), 17 patients with HCM, and 35 normal subjects were studied. From the transmitral Doppler flow velocities, peak early and late (E and A) waves, E/A ratio, and time velocity integrals (Ei and Ai) were calculated. Left atrial active contribution (LAAC) was assessed as the ratio Ei/(Ei + Ai). Furthermore, isovolumetric relaxation time (IVRT) was estimated by means of Doppler echocardiography. In the supine position, the E/A ratio was similar in the 3 groups. Conversely, LAAC was significantly higher in patients with HOCM (24.4 +/- 2.0) and in patients with HCM (23.3 +/- 3.3) compared with normal subjects (20.3 +/- 2.3, P <.001 and P <.05, respectively). After sudden standing, LAAC increased significantly in normal subjects by 11%, in patients with HOCM by 24%, and in patients with HCM by 13% (P <.001). Similarly, IVRT increased significantly in all study groups (P <. 001). By using stepwise forward multiple linear regression analysis, we found that LAAC was associated with age, IVRT, and body mass index in the supine position and with diastolic blood pressure and IVRT in the standing position. CONCLUSIONS: Left atrial contribution to left ventricular filling was increased after sudden changes of posture in normal subjects and in patients with HOCM or HCM.

Adult↗

PubMed2005

Cross-spectral analysis of cardiovascular variables in supine diabetic patients.

Cardiovascular autonomic neuropathy in diabetes is associated with a high risk of mortality, which makes its early identification clinically important. An easy method for identification of subjects with autonomic dysfunction would be of clinical benefit. We evaluated the autonomic function in 28 diabetic patients and 21 control subjects recording 12 min time series of heart period (RR) and systolic arterial pressure (SAP, Finapres) during supine rest and 60 degrees head-up tilt. The power of the high (respiratory) and low (LF approximately 0.1 Hz) frequency oscillations was quantified by spectral analysis. The central frequency of the LF oscillations (LF_freq), phase shift, and the transfer function gain between RR interval and SAP fluctuations were provided by cross-spectral analysis, and measured at the point of maximal coherence. In the supine position 15 patients (LF-) displayed atypical LF variability with the LF_freq being shifted towards lower frequencies (about 0.06 Hz). They also showed larger phase angle, lower values or even absence of coherence and smaller transfer function gain between RR and SAP fluctuations. 13 patients (LF+) and the controls showed the LF_freq around 0.1 Hz, higher coherence and transfer function gain values. The orthostatic maneuver induced the expected changes in the spectral parameters (increase in the LF components of both RR and SAP and decrease in the HF variability of RR) into the LF+ patients and all the control subjects and abnormal response in the other 15 LF-patients. These findings indicate that diabetic subjects with uncharacteristic response to the orthostatic test present abnormal LF variability already in the supine position. Crossspectral parameters while supine may be used for the identification of these subjects.

Adult↗

PubMed2005

Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.

BACKGROUND: In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position. METHOD: Multiple trauma patients of the intensive care units of two university hospitals were considered eligible if they met the criteria for acute lung injury or the acute respiratory distress syndrome. Patients in the prone group (N = 21) were kept prone for at least eight hours and a maximum of 23 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in prone as well as supine position over a period of 48 hours. Patients in the supine group (N = 19) were positioned according to standard care guidelines. RESULTS: The duration of ventilatory support did not differ significantly (30 +/- 17 days in the prone group and 33 +/- 23 days in the supine group). Worst case analysis (death and deterioration of gas exchange) displayed ventilatory support for 41 +/- 29 days in the prone group and 61 +/- 35 days in the supine group (p = 0.06). The PaO2:FiO2 ratio increased significantly more in the prone group in the first four days (p = 0.03). The prevalence of Acute Respiratory Distress Syndrome (ARDS) following acute lung injury (p = 0.03) and the prevalence of pneumonia (p = 0.048) were reduced also. One patient in the prone and three patients in the supine group died due to multi organ failure (p = 0.27). CONCLUSIONS: Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.

Adult↗

PubMed2003

Effect of posture on respiratory function and drive in preterm infants prior to discharge.

Our objective was to determine the effect of posture on respiratory function and drive in prematurely born infants immediately prior to discharge. Twenty infants (6 oxygen-dependent), median gestational age 29 weeks (range, 25-32), were studied at a median postconceptional age (PCA) of 36 weeks (range, 33-39). On 2 successive days, infants were studied both supine and prone; each posture was maintained for 3 hr. The order on each day in which postures were studied was randomized between infants. At the end of each 3-hr period, tidal volume (Vt), inspiratory (Ti) and expiratory (Te) time, respiratory rate, and minute ventilation were measured. In addition, respiratory drive was assessed by measuring the pressure generated in the first 100 msec of an imposed airway occlusion (P(0.1)), and respiratory muscle strength was assessed by recording the maximum inspiratory pressure (Pimax) generated against an occlusion which was maintained for at least five breaths. Overall, tidal volume was higher (P < 0.05), but respiratory rate (P < 0.05), P(0.1) (P < 0.05), and Pimax (P < 0.05) were lower in the prone compared to the supine position. There were no significant differences in Ti or Te between the two postures. In oxygen-dependent infants only, minute volume was higher in the prone position (P < 0.05). In conclusion, posture-related differences in respiratory function are present in prematurely born infants studied prior to neonatal unit discharge.

Drive↗

PubMed1996

Neuromuscular-skeletal constraints upon the dynamics of perception-action coupling.

Four right-handed subjects performed rhythmic flexion and extension movements of the index finger in time with an auditory metronome. On each block of trials the forearm of the response hand was placed in a prone, neutral or supine position. In the flex-on-the-beat condition, subjects were instructed to coordinate maximum excursion in the direction of finger flexion with each beat of the metronome. In the extend-on-the-beat condition, subjects were instructed to coordinate maximum excursion in the direction of finger extension with each beat of the metronome. The frequency of the metronome was increased from 1.75 Hz to 3.50 Hz in eight steps (8-s plateaus) of 0.25 Hz. During trials prepared in the extend-on-the-beat pattern or to phase wandering often occurred, particularly at higher pacing frequencies. In marked constrast, during trials prepared in the flex-on-the-beat pattern such transitions were never present. Both the frequency and the alacrity of these transitions were greater when the forearm was in a prone or neutral position than when the forearm was in a supine position. These results are discussed with reference to the constraints imposed on the coordination dynamics by the intrinsic properties of the neuromuscular-skeletal system.

Adolescent↗

PubMed2002

Intermittent pneumatic compression prevents venous stasis in the lower extremities in the lithotomy position.

PURPOSE: To investigate the interactions of a new lithotomy positioning device (LPD) with two intermittent pneumatic compression (IPC) devices by measuring femoral venous flow velocity. METHODS: Subjects were divided into three groups: 1) supine position as a control, 2) lithotomy position using a conventional LPD, and 3) lithotomy position using a new LPD, Levitator(TM). These three groups were further divided in two according to the type of IPC device used: AV-impulse(TM) (rapid IPC) and SeQuel(TM) (standard IPC). Peak femoral venous flow velocity was measured by using an ultrasonic echo diagnostic device. Data were analyzed by one-way ANOVA with Fisher's test or by the unpaired two-tailed t test. RESULTS: Moving to the conventional lithotomy position from the supine position, venous flow velocity was decreased by 38% in both IPC device groups. Even when the new LPD was used to support the lithotomy position, the flow velocity was decreased by 24%, but the velocity was significantly higher than in the conventional lithotomy position. Both rapid and standard IPC devices increased flow velocity to 77% and 107% (first compression) and to 71% and 84% (fifth compression) of the control values during compression, respectively. In the lithotomy position group using the new LPD, similar increases in flow were seen with the use of IPC devices. CONCLUSION: Both rapid and standard IPC devices are useful for maintaining venous flow of the lower extremities in the lithotomy position.

Blood Flow Velocity↗

PubMed1998

Effects of acute clonidine administration on power spectral analysis of heart rate variability in healthy humans.

1. To investigate the relationship between the autonomic drive to the heart and heart rate variability, as evaluated by power spectral analysis, we studied the effect of clonidine (300 microg), a central sympatholytic agent, on heart rate variability. 2. Six healthy subjects (mean age 31 +/- 3 years) were studied in the supine and the sitting position (15 min each) on two different occasions, respectively, before and after clonidine administration. Using an autoregressive approach, the low frequency (LF) and the high frequency (HF) components of power spectral analysis were measured, and their ratio was calculated. Blood pressure was monitored throughout the study and plasma catecholamines were measured at the end of each period. 3. Before clonidine, assumption of the sitting position induced increases in LF, LF/HF ratio, blood pressure and plasma noradrenaline. Clonidine induced remarkable reductions in the normalized values of the LF component and the LF/HF ratio in both the resting and the sitting position (supine: LF = -68%, LF/HF ratio = -80%; sitting: LF = -23%, LF/HF ratio = -55%) without affecting the central frequencies of LF and HF components. Blood pressure and plasma catecholamines also significantly decreased after clonidine. 4. These results support the hypothesis that the LF component of HRV, expressed in normalized units, is an indicator of the sympathetic control of the heart. In addition, this component seems to be largely of central origin, because it is markedly reduced by the central sympatholytic action of clonidine.

Adult↗

PubMed1996

Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis.

We investigated cardiovascular performance in 12 patients (mean age 66 +/- 12 yr) with significant coexisting cardiopulmonary disease (hypertension, coronary artery disease, chronic obstructive pulmonary disease) during laparoscopic colectomy under general anesthesia. Hemodynamic monitors included arterial and pulmonary artery catheters in combination with transesophageal echocardiography. Hemodynamic and echocardiographic data were obtained at five epochs: baseline (after induction of anesthesia), insufflation (after pneumoperitoneum, supine position), Trendelenburg 5 (5 min after placement into Trendelenburg's position), Trendelenburg 20 (at 20 min in Trendelenburg's position), and end (after release of the pneumoperitoneum, supine position). Hemodynamic responses to peritoneal insufflation resulted in significant increases in systemic vascular resistance (SVR) as well as endsystolic area (ESA) and significant decreases in cardiac index (CI) and ejection fraction area (EFa) compared with baseline. Trendelenburg's positioning augmented ventricular preload and performance, resulting in significant increases in pulmonary capillary wedge pressure, CI, end-diastolic area, and EFa compared with insufflation. At the final epoch, end, a hyperdynamic state occurred as evidenced by a significantly decreased ESA and SVR while heart rate, CI, and EFa increased significantly compared to baseline and insufflation. In an elderly population with significant coexisting cardiopulmonary disease, intraoperative maneuvers required for laparoscopic colectomy resulted in previously undescribed alterations of cardiovascular performance, which persisted after release of the pneumoperitoneum.

Aged↗

PubMed1987

Heart-rate variability in children. Spectral analysis of developmental changes between 5 and 24 years.

The variation in instantaneous heart rate is most prominent in infants and younger subjects. In a preliminary study of the effects of maturation on heart rate, we compared the heart rate variations of 29 children and young adults in three groups between 5 and 24 years of age. We used spectral analysis to determine the intensity of the variations in each of the two main frequency bands in which variations occur: HF, 0.15-0.45 Hz, and LF, 0.03-0.15 Hz. Three-minute segments of continuous instantaneous heart rate were recorded for each subject in standing and supine positions. The group mean LF and HF amplitudes and the L/H ratio decreased between 5 and 10 years of age in both positions, significantly for LF and L/H in the supine position (p less than 0.05). Half of the youngest group of children had adult LF amplitude values by 5 years of age; the others had much higher levels, indicating increased low frequency variation at this age. Thus the high variation in heart rate in very young subjects is most prominent in the LF range. These preliminary results, considered with previous pharmacological studies, suggest that many children have a significant decrease in sympathetic activity between 5 and 10 years of age and possibly a slight decrease in parasympathetic activity. Spectral analysis of heart rate appears a promising technique for investigating the development of neural control of the heart.

Adolescent↗

PubMed1997

Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leukoaraiosis in the older elderly living in a community.

BACKGROUND AND PURPOSE: Postural hypotension, which occurs frequently in community-living, apparently healthy elderly adults, is usually asymptomatic. However, the relation between postural changes in blood pressure and quantitative higher cerebral function or silent brain lesions remains unclear. We examined the association of exaggerated postural changes in systolic blood pressure with cognitive and quantitative neurobehavioral functions and with brain lesions on MRI in the community-dwelling older elderly. METHODS: The study population consisted of 334 community-dwelling elderly adults, aged 75 years or older (mean age, 80 years). Postural changes in systolic blood pressure (SBP) were assessed using an autosphygmomanometer (BP-203 I). By the difference between the mean of two measurements of SBP at standing and at supine position (dSBP = SBP at upright-SBP at supine position), we divided the subjects into three groups: (1) 20 subjects with postural hypotension (d-SBP < or = -20 mm Hg), (2) 29 subjects with postural hypertension (dSBP > or = 20 mm Hg), and (3) 285 subjects with postural normotension (20 < dSBP < 20 mm Hg). We defined the former two groups as the postural dysregulation group. Scores in four neurobehavioral function tests (Mini-Mental State Exam. Hasegawa Dementia Scale Revised, computer-assisted visuospatial cognitive performance score, and the Up and Go Test) and activities of daily living were compared among the three groups. Brain lesions on MRI, including number of lacunes and periventricular hyperintense lesions, were compared among 15 age- and sex-matched control subjects with postural hypotension, 15 with postural hypertension, and 30 with postural normotension. RESULTS: Twenty subjects (6.0%) exhibited postural hypotension and 29 (8.7%) postural hypertension. Scores in neurobehavioral functions and activities of daily living were significantly lower in the postural dysregulation group (both postural hypotension and hypertension groups) than in the postural normotension group. The postural dysregulation group exhibited significantly more advanced periventricular hyperintensities than the normotension group. CONCLUSIONS: Asymptomatic community dwelling elderly individuals with postural hypotension as well as those with postural hypertension had poorer scores on neurobehavioral function tests and more advanced leukoaraiosis demonstrated on MRI than those without exaggerated postural changes in SBP.

Aged↗

PubMed2000

[Respiratory failure due to diaphragmatic dysfunction in Charcot-Marie-Tooth disease: a case report].

A 56-year-woman with type 2 respiratory failure due to diaphragmatic dysfunction in Charcot-Marie-Tooth disease (CMT) is reported. The patient, who had a 50-year history of CMT, was referred to our hospital because of nocturnal dyspnea. Arterial blood gas analysis on admission showed marked hypoxia with hypercapnia, and physical examination revealed thoracoabdominal paradoxus in the supine position. Chest radiography revealed elevation of both sides of the diaphragm. The vital capacity and arterial blood gas pressure in the sitting position were markedly higher than those in the supine position. Electrical phrenic nerve stimulation failed to produce any convincing muscle action potential in the diaphragm. These findings suggested that her respiratory failure was induced by both diaphragmatic dysfunction caused by bilateral phrenic nerve palsy due to CMT. Treatment of this patient was started at home with a pressure support ventilator, resulting in satisfactory clinical improvement. In general, respiratory muscle impairment is a rare phenomenon in a patient with CMT. However when a patient with CMT complains of dyspnea or if unexpected heart failure develops, it is important to keep in mind that CMT may be associated with phrenic nerve palsy.

Charcot-Marie-Tooth Disease↗

PubMed2005

[A case of bilateral diaphragmatic paralysis clinically suggestive of brachial neuritis].

A 55-year-old man complained of acute onset of shoulder pain and dyspnea in the supine position. A diagnosis of bilateral diaphragmatic paralysis was made based on clinical inspection of his breathing pattern, radiographic appearance, and pulmonary function tests. He had had no traumatic or thoracic surgery or inflammatory episode. He did not suffer from diabetes, other central neural diseases, or any neoplastic disease. From the clinical feature and electromyographic findings, phrenic nerve involvement of brachial neuritis without any other muscle involvement was considered as a causative disease. When he received non-invasive intermittent positive-pressure ventilation by nasal mask in a supine position, his dyspnea was substantially attenuated and Carbon dioxide retention was lessened. After 1 year, his shoulder pain is still persisting and radiographic findings are not remarkably improved.

Brachial Plexus Neuritis↗

PubMed2000

Oxygenation response to a recruitment maneuver during supine and prone positions in an oleic acid-induced lung injury model.

Prone position and recruitment maneuvers (RM) are proposed as adjuncts to mechanical ventilation to open up the lung and keep it open. We studied the oxygenation response to a RM (composed of a 30-s sustained inflation at 60 cm H(2)O airway pressure) performed in prone and supine positions in dogs after oleic acid- induced lung injury using an inspired O(2) fraction of 0.60. In one group (n = 6) first supine then prone positions were examined after a RM at 8 cm H(2)O and 15 cm H(2)O of positive end-expiratory pressure (PEEP). In the second group (n = 6) the sequence of positions was reversed. Prone positioning after supine position always improved oxygenation, whereas the decrement in Pa(O(2)) was relatively small when dogs were returned to the supine position. Oxygenation improved in both groups after a RM, and the improvement was sustained (after 15 min) in the prone position at 8 cm H(2)O of PEEP, but 15 cm H(2)O of PEEP was required in supine position. Our results suggest that a RM improves oxygenation more effectively with a decreased PEEP requirement for the preservation of the oxygenation response in prone compared with supine position.

Animals↗

PubMedDate not supplied

New method of electrode placement for determination of cardiac output using impedance cardiography.

In thirty eight young healthy adult subjects, cardiac output was determined non-invasively by using two methods of electrode placement viz. vertical (uses silver braided wires in a band shape) and horizontal (conventional stick-on type surface ECG electrodes), using the technique of Impedance Cardiography. The recordings were taken in supine position on the same day in two separate sets with 30.0 min interval between two sets. In each set of recording, five successive recordings, each at an interval of five minutes were taken. The mean values of cardiac out put by two methods were compared. For the set I, the respective values (Mean +/- SD) of cardiac output by horizontal and vertical methods for the each of the five recordings were 4.87 +/- 0.77 and 5.03 +/- 0.64 for the first, 4.87 +/- 0.71 and 4.91 +/- 0.66 for the second, 4.99 +/- 0.67 and 5.00 +/- 0.70 for the third, 4.78 +/- 0.69 and 4.98 +/- 0.61 for the fourth, 4.84 +/- 0.69 and 4.98 +/- 0.62 for the fifth recording in supine position. The respective P values for these pairs for between the group comparisons were 0.33, 0.50, 0.96, 0.17, and 0.36. In addition, to see the repeatability for each method, within the group comparison was done, the P values were 0.71 and 0.91 for the horizontal and vertical methods, respectively. The mean value of cardiac output did not differ significantly between two methods for recordings of set II in supine position. The cardiac output measurement by placing four spot electrodes horizontally, gave consistent result on repeated measurements and their values showed concordance with the cardiac output values obtained by conventional four band electrodes tied around the chest.

Adult↗

PubMed2003

Prone ventilation following witnessed pulmonary aspiration: the effect on oxygenation.

OBJECTIVE: Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on pulmonary aspiration. DESIGN: A prospective crossover study. SETTING: Twelve-bed ITU. PATIENTS AND PARTICIPANTS: Eleven patients admitted to ITU with respiratory failure secondary to witnessed pulmonary aspiration requiring ventilation and an FIO(2) >0.50 after 12 h. INTERVENTIONS: Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO(2) remained >0.50. Ventilator settings were not altered in the study period. MEASUREMENTS AND RESULTS: Arterial blood gas analysis was performed every 2 h. The PaO(2)/FIO(2) gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO(2)/FIO(2) ratio ( P<0.01). There was a fall in this gradient on return to the supine position. There was a significant improvement in oxygenation on turning prone for the second period ( P<0.01). Overall, there was a significant improvement in the PaO(2)/FIO(2) ratio in the final supine position when compared to the first ( P<0.05). CONCLUSION: This study demonstrates a significant improvement in oxygenation in the prone position in pulmonary aspiration. Early prone positioning in patients with pulmonary aspiration requiring ventilation may improve oxygenation by altering V/Q relationships similarly to ARDS, but also may aid drainage of secretions, opening up alveoli and preventing progression to established pneumonitis.

Adult↗

PubMed1989

Physiologic effects of steep positioning in the surgical intensive care unit.

Ten hemodynamically stable patients requiring mechanical ventilation for radiographically symmetric acute lung disease were studied during steep lateral positioning and continuous rotation in a Roto Rest kinetic treatment bed. There were no significant hemodynamic or ventilatory differences among the four positions (supine, right side down, left side down, and rotating). In four patients, arterial oxygen pressure (PaO2) decreased 16% to 49% in the lateral position when compared with the supine position. Continuous rotation restored the PaO2 toward the supine value in each patient. In six patients, PaO2 increased 11% to 35% during lateral positioning. In five of the six patients, the increase in PaO2 differed between sides, suggesting asymmetric lung disease. Continuous rotation did not significantly alter the PaO2 from the supine values in these patients. Adverse effects on oxygenation caused by positional changes may be reversed by continuous rotation using the Roto Rest kinetic bed.

Adult↗

PubMed2005

Influence of acute unilateral vestibular lesions on the respiratory rhythm after active change of posture in human subjects.

The influence of acute unilateral vestibular lesions on respiratory rhythm after active change of posture, was evaluated by comparing responses from patients with acute vestibular neuritis, with those from normal subjects with minor injuries other than vestibular (e.g. epistaxis, headache) and patients with chronic bilateral vestibular dysfunction. Respiratory movements of the thorax-abdomen were recorded during 5 minutes in supine position, 5 minutes of back-unsupported sitting and 5 minutes of upright stance. Compared to supine position, sitting-up induced different responses in each group (p < 0.05, ANOVA). The healthy subjects showed a consistent decrease in the mean respiratory frequency related to an increase of the expiration time, which was absent in patients with vestibular neuritis. Subjects with minor injuries showed the opposite changes of expiration time and inspiration time with no change of the respiratory frequency and patients with bilateral vestibular dysfunction showed a trend to increase their respiratory frequency. Standing-up did not evoke any further changes in any group. We conclude that the vestibular system modulates the respiratory response to reorientation of the head and trunk to upright position and this influence is reduced during the acute stage of a vestibular lesion.

Acute Disease↗

PubMed1996

[Change of position and the decrease in the cases of sudden infant death syndrome in Navarra].

The prone position during sleep has been described as the most important risk factor in relationship to sudden infant death syndrome (SIDS). The prevalence of infants that sleep in the prone position and its relationship with SIDS has not been studied in our country. A survey was performed in a population of children born in Navarra between February 1, 1992 and February 1, 1993. We found that 86.5% of these children sleep in the prone position, 5.6% in the supine position and 3.5% on their side. In March 1993 a campaign was begun that recommended that the prone position not be used for infants from the time of birth until 6 months of age. After this campaign, in a sample of 441 children, born between May 1, 1993 and May 1, 1994, only 38.3% of the infants continued to sleep in the prone position, while 46% did so supine and 9% slept on their side. The number of deaths in Navarra as a result of SIDS during the period of 1985 through 1993 was 1.3% of live births with a mean of 6.3 deaths/year. The number of infant deaths after the change of sleeping position, in 1994, was 0.42% of live births, with 2 deaths as a result of SIDS during this year. In Navarra, the decrease in the number of infants sleeping in the prone position has been accompanied by a significant decline in the number of deaths due to SIDS.

Humans↗