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Results for “Prone Position”

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PubMed1987

Head-erect behavior among three preschool-aged children with cerebral palsy.

This article presents the results of a multiple baseline design, across subjects, to assess the effect of vibratory stimulation on head-erect behavior in subjects who were prone. The subjects were three children with severe multiple handicaps whose mean age was 2 years 4 months and whose conditions included seizures and muscle tone disorders. Frequency of head lifts and cumulative duration of head-erect behavior were recorded during three-minute sessions with the subjects positioned prone on their forearms over a wedge. After baseline observations were recorded, vibration was applied to the paraspinal muscles of the neck and upper back for the first two minutes of each intervention session. In addition, electromyographic activity was recorded for a three-minute session at least once during both the baseline and intervention conditions. Results of the study demonstrated an increase in the cumulative duration of head-erect behavior for the three subjects and an accompanying increase in EMG activity during muscle vibration. The diversity of handicapping conditions (ie, seizures, hypertonia, and hypotonia) appeared to have no effect on the benefits received from muscle vibration for these subjects. Limitations of the study and implications for future research are discussed.

Behavior Therapy↗

PubMed2006

[Guidelines for management of acute lung injury/acute respiratory distress syndrome: an evidence-based update by the Chinese Society of Critical Care Medicine (2006)].

OBJECTIVE: In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. METHODS: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. RESULTS: It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve. Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended. The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. CONCLUSION: Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.

Acute Lung Injury↗

PubMed1982

Effectiveness of positioning therapy for gastroesophageal reflux.

The therapeutic effects of positioning and state of alertness were evaluated in 79 patients with gastroesophageal reflux (GER) and 49 nonreflux patients by extended esophageal pH monitoring during the two-hour postprandial period. The amount of GER in nonreflux patients was not significantly affected by changes in position or state or alertness whereas patients with GER demonstrated consistent decreases in the percent time and frequency of reflux episodes while asleep compared wtih being awake. In patients with GER, less reflux occurred while upright than supine during awake but not during asleep periods. The 30-degree elevated prone position was superior to the supine or upright positions while patients were awake or asleep. A beneficial effect of the 30-degree elevated supine position was not noted. Patients with respiratory disease, with severe esophagitis, or who required surgical correction of GER all responded to positioning or alertness changes in the same manner.

Child, Preschool↗

PubMed1999

Hoffmann-reflex is delayed during 6 degree head-down tilt with balanced traction.

BACKGROUND: Increased spinal height due to the lack of of axial compression on spinal structures in microgravity may stretch the spinal cord, cauda equina, nerve roots, and paraspinal tissues. HYPOTHESIS: Exposure to simulated microgravity causes dysfunction of nerve roots so that the synaptic portion of the Achilles tendon reflex is delayed. METHODS: Six healthy male subjects were randomly divided into two groups with three in each group. The subjects in the first group underwent horizontal bed rest (HBR) for three days. After a two week interval they underwent bed rest in a position of head-down tilt with balanced traction (HDT). So that each subject could serve as his own control, the second group was treated identically but in opposite order. Bilateral F waves and H-reflexes were measured daily (18:30-20:30) on all subjects placed in a prone position. RESULTS: By means of ANOVA, differences between HDT and HBR were observed only in M-latency and F-ratio, not in F-latency, central latency, and H-latency. Differences during the course of the bed rest were observed in M-latency and H-latency only. Tibial H latency was significantly lengthened in HDT group on day 2 and 3, although no significant difference between HDT and HBR was observed. CONCLUSION: The monosynaptic reflex assessed by H-reflex was delayed during 6 degree HDT with traction. The exact mechanism of this delay and whether the change was due to lengthening of the lower part of the vertebrae remain to be clarified.

Action Potentials↗

PubMedDate not supplied

CT image fusion as a tool for measuring in 3D the setup errors during conformal radiotherapy for prostate cancer.

AIMS AND BACKGROUND: The importance of optimal daily patient positioning has been stressed in order to ensure treatment reproducibility and gain in accuracy and precision. We report our data on the 3D setup uncertainty during radiation therapy for prostate cancer using the CT image fusion technique. METHODS: Ten consecutive patients scheduled for radiation therapy for prostate cancer underwent 5 prone position CT scans using an individualized immobilization cast. These different setups were analyzed using the image fusion module of the ERGO 3D-Line Medical System (Milan, Italy) treatment planning system. The isocenter and the body marker displacements were measured. RESULTS: The 3D isocenter dislocations were quantified: systematic error was sigma(3D) = 3.9 mm, whereas random error was sigma(3D) = 1 mm. The mean of the minimum displacements was 0.2 +/- 1 mm showing that the immobilization device used allows an accurate setup to be obtained. Single direction errors were also measured showing systematic errors, sigma(AP), = 2.6 mm, sigma(LL) = 0.6 mm, SigmaSI = 3 mm in the anterior-posterior, latero-lateral, superior-inferior direction, respectively. Related random errors were sigma(AP), = 1 mm, sigma(LL) = 0.6 mm, sigma(SI) = 1.2 mm. In terms of accuracy, our uncertainties are similar to those reported in the literature. CONCLUSIONS: By applying the CT image fusion technique, a 3D study on setup accuracy was performed. We demonstrated that the use of an individualized immobilization system for prostate treatment is adequate to obtain good setup accuracy, as long as a high-quality positioning control method, such as the stereoscopic X-ray-based positioning system, is used.

Aged↗

PubMed1982

Intracranial delivery of metrizamide from the lumbar subarachnoid space: prone versus supine positioning.

Forty patients undergoing metrizamide computed tomographic cisternography (MCTC) were prospectively evaluated for the relative merits of prone and supine positioning for the intracranial delivery of the subarachnoid contrast material. Twenty patients were prone and 20 supine when tilted head downward. The degree of opacification was deemed satisfactory or unsatisfactory in each case for the various ventricles and for the suprasellar, quadrigeminal, perimesencephalic, and cerebellopontine angle cisterns. The visualization of the suprasellar and perimesencephalic cisterns was much more often satisfactory using a prone delivery (p less than or equal to 0.05 by Fisher exact test). None of these structures was opacified significantly better with the patient supine. A prone delivery is therefore recommended for most of the common indications for MCTC.

Humans↗

PubMed1990

[A comparative evaluation of the centering precision performed with 2 different stereotaxic instruments in nonpalpable breast lesions].

Two different instruments for nonpalpable breast lesion localization, with different patient position (prone and sitting), were evaluated in precision performances by measuring the mean needle deviation on X and Y axes in 150 and 100 examinations, respectively. Both instruments yielded precise information: some drawbacks were observed with the stereotaxic instrument fitted to the plain mammographic unit, due to imperfect fixation in the sitting position of the patient. The development of special seats could obviate the problem, thus allowing a further improvement in the performance of this kind of instruments.

Biopsy, Needle↗

PubMed1989

Clinical evaluation of esophageal doppler cardiac output measurement during general anesthesia.

We evaluate the accuracy of cardiac output measurement with esophageal Doppler ultrasonography (ECO). A total of 71 simultaneous measurement of esophageal Doppler and thermodilution cardiac output were compared in 16 patients undergoing general anesthesia in the supine position. ECO was determined easily with minimal experience, and significantly correlated with thermodilution cardiac output (TDCO) measurement ( P < 0.001). The regression equation obtained was Y = 0.983X + 0.019, and the correlation coefficient was 0.935. Furthermore, ECO was more reproducible than TDCO. However, ECO is not able to assess CO accurately in either lateral or prone position and after cardiopulmonary bypass in open heart surgery. Our results suggest that the esophageal Doppler technique allows a noninvasive and continuous cardiac output monitoring in patients during general anesthesia, and that it is more useful in patients for whom invasive monitoring is considered inappropriate. However, further improvement in this technique will be necessary for its routine use in clinical anesthesia.

Journal Article↗

PubMed2004

Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients. PURPOSE: To develop an evidence-based guideline for the prevention of VAP. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. STUDY SELECTION: The authors systematically searched for relevant randomized, controlled trials and systematic reviews that involved mechanically ventilated adults and were published before 1 April 2003. DATA EXTRACTION: Physical, positional, and pharmacologic interventions that may influence the development of VAP were considered. Independently and in duplicate, the authors scored the validity of trials; the effect size and confidence intervals; the homogeneity of results; and safety, feasibility, and economic issues. DATA SYNTHESIS: Recommended: The orotracheal route of intubation, changes of ventilator circuits only for each new patient and if the circuits are soiled, use of closed endotracheal suction systems that are changed for each new patient and as clinically indicated, heat and moisture exchangers in the absence of contraindications, weekly changes of heat and moisture exchangers, and semi-recumbent positioning in the absence of contraindications. Consider subglottic secretion drainage and kinetic beds. Not recommended: Sucralfate to prevent VAP in patients at high risk for gastrointestinal bleeding and topical antibiotics to prevent VAP. Because of insufficient or conflicting evidence, no recommendations were made about systematically searching for maxillary sinusitis, chest physiotherapy, the timing of tracheostomy, prone positioning, prophylactic intravenous antibiotics, or intravenous plus topical antibiotics. LIMITATIONS: No formal economic analysis was performed, and patient perspectives were not considered. CONCLUSION: If effectively implemented, this guideline may decrease the morbidity, mortality, and costs of VAP in mechanically ventilated patients.

Antibiotic Prophylaxis↗

PubMed1997

[Application of heparin-coated percutaneous cardiopulmonary support system to elective cardiac and aortic operations].

Non emergency use of heparin-coated percutaneous cardiopulmonary support (PCPS) in cardiovascular surgery was applied in 4 patients (3 patients with descending aortic aneurysm, and one with aortic valvular stenosis and impaired left ventricular contractility (LVEF = 0.18). In aortic surgery, femoral inflow and outflow cannulae were inserted after introduction of anesthesia, and low flow F F bypass was established with the patient in supine position. Subsequently lateral posture was taken for aortic grafting. Activated clotting time was kept around 200 sec during the whole operative period and F F bypass was continued after the grafting procedure, and the cannulae were removed when the patient posture was returned to supine. With this method cannulation and decannulation were easy, and almost prone position, which was sometimes necessary for dissection of the adhesion of lung to the posterior aspect of the aneurysmal wall, was easily performed. Because of the percutaneous insertion, there was no local hemorrhage in the groin. Heparin coating circuit permitted only low grade systemic anticoagulation during the operative period, which could lead to decreased amount of hemorrhage. Long F F bypass without full heparinization made no harmful effect on patients' coagulability nor their hemodynamic status. For the patient with extremely impaired cardiac contractility, "scheduled PCPS and IABP" was proved to be safe, reliable, and cost-effective: F F bypass was established before sternotomy, and intracardiac procedure with aortic crossclamping was performed under total cardiopulmonary bypass using PCPS. After declamping of the aorta, weaning from the bypass was not tried and total anticoagulation was reversed with protamine. Then the sternum was closed and patient was transferred to ICU with the PCPS and IABP on. After more than 10 hours, when the cardiac contractility recovered from the intraoperative ischemic insult to a considerable degree, weaning from PCPS was successfully accomplished.

Adult↗

PubMed2006

Neuromuscular electrical stimulation and an ottoman-type seat effectively improve popliteal venous flow in a sitting position.

The aim of this study was to examine the effects of the sitting posture on the lower limb venous flow and to explore the beneficial effects of neuromuscular electrical stimulation (NMES) and an ottoman-type seat on the venous flow. Healthy adult volunteers without a history of lower limb surgery or thromboembolism were recruited, and the flow velocity, cross-sectional area, and flow volume of the popliteal vein were measured using Doppler ultrasound. A posture change from the prone position to the sitting position on the ottoman-type seat decreased the flow velocity and increased the cross-sectional area of the popliteal vein, and the flow volume was not altered over 120 min. The flow velocity was further decreased, and the cross-sectional area was further increased by subjects sitting on a regular driving seat when compared with the values obtained with an ottoman-type seat. The popliteal flow velocity in the NMES leg was significantly higher than in the non-NMES leg throughout the 120-min testing in the sitting position, but no difference in the cross-sectional area was found between the NMES and the non-NMES legs. Thus lower limb venous stasis elicited by the sitting posture was improved by the ottoman-type seat and NMES.

Adult↗

PubMed1993

MR imaging of silicone breast implants: comparison of different coil arrays.

To determine the optimal coil and patient position for magnetic resonance imaging of patients with silicone breast implants, images obtained with body, circular surface, flexible, single shoulder, and dual shoulder coils in various numbers of patients were compared with regard to signal-to-noise ratio (S/N), decay of signal intensity, resolution, and key area coverage. Images obtained with the dual shoulder coil and prone position, with a customized positioning device, gave the best S/N, resolution, and coverage of the breasts and axillae.

Breast↗

PubMed1997

99Tcm-sestamibi scintimammography in patients with suspicious breast lesions: comparison of SPET and planar images in the detection of primary tumours and axillary lymph node involvement.

Planar scintimammography with 99Tcm-sestamibi (99Tcm-MIBI) has been shown to be useful in diagnosing breast carcinoma. The aim of this study was to compare single photon emission tomography (SPET) and planar imaging for scintimammography with 99Tcm-MIBI in the detection of primary breast cancer and axillary lymph node involvement. Sixty-three females with mammographically suspicious lesions and 12 controls were evaluated. Dynamic images were acquired commencing immediately after the injection of the radiopharmaceutical, followed by multiple planar images in the supine and prone positions plus SPET supine imaging. A final histopathological diagnosis was achieved after surgery. A total of 66 breast lesions were considered. No focal uptake of 99Tcm-MIBI was observed in the breasts or axillas of the controls. In the patients with breast cancer, the sensitivity was 92.9% (39/42) for SPET, 71.4% (30/42) for supine and 85.7% (36/42) for prone planar imaging, respectively; the specificity was 87.5% for SPET and 91.6% for the planar scans. Metastatic axillary lymph node involvement was seen in 19 patients: the sensitivity was 84.2% (16/19) for SPET and 63.2% (12/19) for planar images; the specificity was 91.3% and 95.7% respectively. Our results confirm the high diagnostic accuracy of 99Tcm scintimammography in the diagnosis of breast cancer, and suggest that SPET is more sensitive than planar images, especially in detecting axillary lymph node involvement.

Adult↗

PubMed2000

Patient positioning in prostate radiotherapy: is prone better than supine?

PURPOSE: To assess potential dose reductions to the rectum and to the bladder with three-dimensional conformal radiotherapy (3D-CRT) to the prostate in the prone as compared with the supine position; and to retrospectively evaluate treatment position reproducibility without immobilization devices. METHODS AND MATERIALS: Eighteen patients with localized prostate cancer underwent pelvic CT scans and 3D treatment planning in prone and supine positions. Dose-volume histograms (DVHs) were constructed for the clinical target volume, the rectum and the bladder for every patient in both treatment positions. "Comparative DVHs" (cDVHs) were defined for the rectum and for the bladder: cDVH was obtained by subtracting the organ volume receiving a given dose increment in the prone position from the corresponding value in the supine position. These values were then integrated over the entire dose range. The prescribed dose to the planning target volume (PTV) was 74 Gy using a 6-field technique. To evaluate reproducibility, portal films were subsequently reviewed in 12 patients treated prone and 10 contemporary patients treated supine (controls). No immobilization devices were used. Deviations in the anterio-posterior (X) and cranio-caudal (Y) axes were measured. Mean treatment position variation, total setup variation, systematic setup variation, and random setup variation were obtained. RESULTS: Prone position was associated with a higher dose to the rectum or to the bladder in 6 (33%) and 7 (39%) patients, respectively. A simultaneously higher dose to rectum and bladder was noted in 2 (11%) patients in prone and in 7 (39%) patients in supine. Rectal and bladder volumes were frequently larger in prone than in supine: mean prone/supine volume ratios were 1.21 (SD, 0.68) and 1.03 (SD, 1.32), respectively. In these cases cDVH analysis more often favored the prone position. Mean treatment position variation and total setup variation were similar for both prone and supine plans. A higher systematic setup variation was observed in prone positioning: 2.7 mm vs. 1.9 mm (X axis) and 4.1 mm vs. 2.2 mm (Y axis). The random variation was similar for both prone and supine: 4. 0 mm vs. 3.6 mm (X axis) and 3.7 mm vs. 3.6 mm (Y axis). CONCLUSIONS: Prone position 3D-CRT is frequently, but not always, associated with an apparent dose reduction to the rectum and/or to the bladder for prostate cancer patients. As suggested by the increased mean prone/supine rectal volume ratio, the advantage of prone positioning for the rectum may be artifactual, at least partly reflecting a position-dependent rectal air volume, which may significantly vary from treatment to treatment. In the absence of immobilization devices, daily setup reproducibility appears less accurate for the prone position, primarily due to systematic setup variations.

Aged↗

PubMed1985

Cervical facet joint arthrography.

We describe a technique for cervical facet joint arthrography; a posterior approach is used. The patient is positioned prone, the neck flexed maximally, and the head turned 60-90 degrees opposite to the side of injection. The x-ray tube is angled cephalad in order to obtain a true tangent to the facet joint. The needle is inserted using fluoroscopic control in a direction parallel to the x-ray beam. Before the therapeutic infiltration, the intraarticular position of the needle is confirmed by injecting 0.3 ml of contrast medium.

Arthrography↗

PubMed1980

[Cervical root avulsion in metrizamide myelography].

Until now, the demonstration of cervical root pockets after root avulsion by means of the oily contrast medium Pantopaque has been considered to be the method of choice. Since Pantopaque usually cannot be completely tapped from the cerebrospinal fluid space and the authors have gained comprehensive and good experiences with the new water-soluble contrast medium Amipaque we have used this also for the demonstration of such empty root pockets. Technically, we have used the lateral cervical fluid space puncture between the first and the second cervical vertebra. The patient is placed in a lateral position, the pelvis slightly elevated and the head padded with a pillow. The cervical vertebral column is thus given a slightly lateral curvature, the root pockets from the deepest point, so that the contrast medium Metrizamide can run into them. Sometimes tomography is used. When treating a baby, the lateral cervical puncture was performed with the patient lying in a prone position, so that the root pockets could be demonstrated on both sides.

Diagnosis, Differential↗

PubMed2001

Can imaginary head tilt shorten postrotatory nystagmus?

In healthy subjects, head tilt upon cessation of a constant-velocity yaw head rotation shortens the duration of postrotatory nystagmus. The presumed mechanism for this effect is that the velocity storage of horizontal semicircular canal inputs is being discharged by otolith organ inputs which signal a constant yaw head position when the head longitudinal axis is no longer earth-vertical. In the present study, normal subjects were rotated head upright in the dark on a vertical-axis rotational chair at 60 degrees/s for 75 s and were required to perform a specific task as soon as the chair stopped. Horizontal position of the right eye was recorded with an infra-red video camera. The average eye velocity (AEV) was measured over a 30-s interval following chair acceleration/deceleration. The ratios (postrotatory AEV/perrotatory AEV) were 1.1 (SD 0.112) when subjects (N=10) kept their head erect, 0.414 (SD 0.083) when subjects tilted their head forward, 1.003 (SD 0.108) when subjects imagined watching a TV show, 1.012 (SD 0.074) when subjects imagined looking at a painting on a wall, and 0.995 (SD 0.074) when subjects imagined floating in a prone position on a lake. Thus, while actual head tilt reduced postrotatory nystagmus, the imagination tasks did not have a statistically significant effect on postrotatory nystagmus. Therefore, velocity storage does not appear to be under the influence of cortical neural signals when subjects imagine that they are floating in a prone orientation.

Acceleration↗

PubMed2001

Achilles tendon surgery: S-shaped surgical approach and postoperative positioning to minimize wound tension and external pressure.

For Achilles tendon surgery, an S-shaped incision may be made crossing the midline proximal to the transverse skin creases above the top of the heel counter. This incision provides wide exposure of the tendon and enables wound closure with minimal skin tension. After surgery, direct external pressure on the wound and dependent swelling of the Achilles tendon region, which may increase risks for wound dehiscence and infection, are minimized by laying the patient in the lateral decubitus or prone position to elevate the heel.

Achilles Tendon↗