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Attention, Perception & Psychophysics Jan 2024Magnetoencephalography (MEG) can measure brain activity in ms-level temporal resolution. MEG sensors are super sensitive devices for magnetic signals of the brain but...
Magnetoencephalography (MEG) can measure brain activity in ms-level temporal resolution. MEG sensors are super sensitive devices for magnetic signals of the brain but are also prone to electromagnetic interferences. The MEG device is located inside the magnetically shielded room (MSR), and any monitoring device used inside the MSR requires special shielding and its location must be carefully selected to suppress electromagnetic interference. Eye-tracker measures eye movements, providing spatial location of the gaze, pupil diameters, and eye blinks. Eye tracking in MEG enables, for example, categorization of the MEG data based on gaze position and interactive stimulus using gaze position. Combining the methods together will require considering the electromagnetic interference for the MEG-that is, additional shielding, positioning of the eye tracker, and subject-specific issues related to make-up and eye-corrective lenses.
PubMed: 38291204
DOI: 10.3758/s13414-024-02847-0 -
The Cochrane Database of Systematic... Oct 2023Lumbar puncture is a common invasive procedure performed in newborns for diagnostic and therapeutic purposes. Approximately one in two lumbar punctures fail, resulting... (Review)
Review
BACKGROUND
Lumbar puncture is a common invasive procedure performed in newborns for diagnostic and therapeutic purposes. Approximately one in two lumbar punctures fail, resulting in both short- and long-term negative consequences for the clinical management of patients. The most common positions used to perform lumbar puncture are the lateral decubitus and sitting position, and each can impact the success rate and safety of the procedure. However, it is uncertain which position best improves patient outcomes.
OBJECTIVES
To assess the benefits and harms of the lateral decubitus, sitting, and prone positions for lumbar puncture in newborn infants.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 24 January 2023.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) and quasi-RCTs involving newborn infants of postmenstrual age up to 46 weeks and 0 days, undergoing lumbar puncture for any indication, comparing different positions (i.e. lateral decubitus, sitting, and prone position) during the procedure.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. We used the fixed-effect model with risk ratio (RR) and risk difference (RD) for dichotomous data and mean difference (MD) and standardized mean difference (SMD) for continuous data, with their 95% confidence intervals (CI). Our primary outcomes were successful lumbar puncture procedure at the first attempt; total number of lumbar puncture attempts; and episodes of bradycardia. We used GRADE to assess the certainty of evidence for each outcome.
MAIN RESULTS
We included five studies with 1476 participants. Compared to sitting position: lateral decubitus position may result in little to no difference in successful lumbar puncture procedure at the first attempt (RR 0.93, 95% CI 0.85 to 1.02; RD -0.04, 95% CI -0.09 to 0.01; I = 70% and 72% for RR and RD, respectively; 2 studies, 1249 infants, low-certainty evidence). None of the studies reported the total number of lumbar puncture attempts. Lateral decubitus position likely increases episodes of bradycardia (RR 1.72, 95% CI 1.08 to 2.76; RD 0.03, 95% CI 0.00 to 0.05; number needed to treat for an additional harmful outcome (NNTH) = 33; I = not applicable and 69% for RR and RD, respectively; 3 studies, 1279 infants, moderate-certainty evidence) and oxygen desaturation (RR 2.10, 95% CI 1.42 to 3.08; RD 0.06, 95% CI 0.03 to 0.09; NNTH = 17; I = not applicable and 96% for RR and RD, respectively; 2 studies, 1249 infants, moderate-certainty evidence). The evidence is very uncertain regarding the effect of lateral decubitus position on time to perform the lumbar puncture (MD 2.00, 95% CI -4.98 to 8.98; I = not applicable; 1 study, 20 infants, very low-certainty evidence). Lateral decubitus position may result in little to no difference in the number of episodes of apnea during the procedure (RR not estimable; RD 0.00, 95% CI -0.03 to 0.03; I = not applicable and 0% for RR and RD, respectively; 2 studies, 197 infants, low-certainty evidence). No studies reported apnea defined as number of infants with one or more episodes during the procedure. Compared to prone position: lateral decubitus position may reduce successful lumbar puncture procedure at first attempt (RR 0.75, 95% CI 0.63 to 0.90; RD -0.21, 95% CI -0.34 to -0.09; number needed to treat for an additional beneficial outcome = 5; I = not applicable; 1 study, 171 infants, low-certainty evidence). None of the studies reported the total number of lumbar puncture attempts or episodes of apnea. Pain intensity during and after the procedure was reported using a non-validated pain scale. None of the studies comparing lateral decubitus versus prone position reported the other critical outcomes of this review.
AUTHORS' CONCLUSIONS
When compared to sitting position, lateral decubitus position may result in little to no difference in successful lumbar puncture procedure at first attempt. None of the included studies reported the total number of lumbar puncture attempts. Furthermore, infants in a lateral decubitus position likely experience more episodes of bradycardia and oxygen desaturation, and there may be little to no difference in episodes of apnea. The evidence is very uncertain regarding time to perform lumbar puncture. Pain intensity during and after the procedure was reported using a pain scale that was not included in our prespecified tools for pain assessment due to its high risk of bias. Most study participants were term newborns, thereby limiting the applicability of these results to preterm babies. When compared to prone position, lateral decubitus position may reduce successful lumbar puncture procedure at first attempt. Only one study reported on this comparison and did not evaluate adverse effects. Further research exploring harms and benefits and the effect on patients' pain experience of different positions during lumbar puncture using validated pain scoring tool may increase the level of confidence in our conclusions.
Topics: Infant, Newborn; Infant; Humans; Spinal Puncture; Apnea; Bradycardia; Pain; Oxygen
PubMed: 37870133
DOI: 10.1002/14651858.CD015592.pub2 -
Acta Oncologica (Stockholm, Sweden) Sep 2023Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most...
OBJECTIVE
Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data.
METHODS
REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone ( = 268) versus supine ( = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years.
RESULTS
At the last treatment fraction, there was no significant difference in dermatitis ( = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema ( < .001). At 2 years, patients treated in prone position had less atrophy ( = .01), and higher body image ( < .001), and social functioning ( < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years ( = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, < .001).
CONCLUSIONS
Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.
PubMed: 37548182
DOI: 10.1080/0284186X.2023.2240486 -
Ear, Nose, & Throat Journal Jul 2023Supine position reduces nasal patency compared with that in the sitting position; however, data on the effects of prone position on nasal patency is lacking.
OBJECTIVES
Supine position reduces nasal patency compared with that in the sitting position; however, data on the effects of prone position on nasal patency is lacking.
METHODS
We assessed the nasal patency of 30 healthy individuals without upper respiratory tract disorders by using visual analog scale (VAS) score and acoustic rhinometry in 7 positions: sitting; frontal, right, and left supine; and frontal, right, and left prone.
RESULTS
According to the VAS scores, compared with that in the sitting position, both the supine and prone positions significantly increased subjective nasal obstruction ( < .001). The prone position had a more significant effect than did the supine position ( = .017). The results of minimal cross-sectional area measured through acoustic rhinometry demonstrated that both the supine and prone positions reduced the nasal patency significantly, but without significant differences between the effects of prone and supine positions ( = .794).
CONCLUSION
This is the first study to elucidate that the prone position can significantly reduce the nasal patency in healthy individuals through subjective and objective assessments.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Prone Position; Nose; Nasal Obstruction; Rhinometry, Acoustic; Supine Position
PubMed: 33970694
DOI: 10.1177/01455613211015437 -
Urology Annals 2023The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages.
OBJECTIVE
The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages.
MATERIAL AND METHODS
Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO, stone size, stone location, procedural type, position, procedure duration, PaO, SaO, PaCO, pH, and dynamic compliance. PaO, SaO, PaCO pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure.
RESULTS
Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO at the beginning, SaO at the beginning and at the end of the procedure, PaCO at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery.
CONCLUSIONS
Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO and a drop in PaCO gradually from the beginning to the end of the surgery.
PubMed: 37664107
DOI: 10.4103/ua.ua_113_22 -
The Annals of Thoracic Surgery May 2024Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about...
BACKGROUND
Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation.
METHODS
Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pao/fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418).
RESULTS
Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned for a median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pao/fraction of oxygen in inhaled air (227 ± 96 vs 303 ± 127 mm Hg, P = .004), and lower lung compliance (24.8 ± 9.1 mL/mbar vs 29.8 ± 9.7 mL/mbar, P < .001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pao/fraction of oxygen ratio: 331 ± 91 mm Hg; lung compliance: 31.7 ± 20.2 mL/mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P = .105).
CONCLUSIONS
Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation.
Topics: Humans; Lung Transplantation; Prone Position; Male; Female; Middle Aged; Retrospective Studies; Adult; Patient Positioning; Pulmonary Gas Exchange; Treatment Outcome
PubMed: 37150273
DOI: 10.1016/j.athoracsur.2023.04.036 -
Medicine, Science, and the Law Oct 2023There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint...
There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint death is essentially the end-result of a violent physical altercation wherein a combative individual suddenly loses consciousness while trying to counteract an opposing force. The direct correlations of increased static weight force with decreased inferior vena cava diameter, decreased cardiac output, and decreased stroke volume in prone restraint studies suggest that decreased venous return and decreased cardiac output could have a significant role to play in prone restraint death. Although the degree of changes observed in those studies might not be sufficient to cause cardiac arrest, they could predispose people who instinctively try to free themselves of the restraints to severe complications. The Valsalva maneuver, or forceful expiration against a closed airway, is frequently performed spontaneously in daily activities involving straining and resistance exercise, but has never been considered in restraint death. Pre-existing diminished venous return could increase the risk of major complications in individuals performing the Valsalva maneuver. A substantial decrease in venous return and cardiac output could increase the risk of cerebral hypoperfusion, loss of consciousness, hypoventilation, and sudden death. By increasing the risk of increased intra-abdominal pressure and its negative effect on venous return, high body mass index may be a significant risk factor in prone restraint death. The Valsalva maneuver may have different roles in prone restraint cardiac arrest and might be overlooked in prone restraint death.
Topics: Humans; Valsalva Maneuver; Restraint, Physical; Cardiac Output; Heart Arrest; Veins
PubMed: 36949719
DOI: 10.1177/00258024231162841 -
Critical Care Nurse Dec 2023Patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) and may undergo prone positioning.
BACKGROUND
Patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) and may undergo prone positioning.
OBJECTIVE
To compare the effects of prone positioning on oxygenation, intensive care unit length of stay, and intubation days in patients with COVID-19 ARDS and patients with non-COVID-19 ARDS.
METHODS
A convenience sample of intubated patients with COVID-19 and moderate to severe ARDS (per Berlin criteria) was compared with historical data from a retrospective, descriptive medical record review of patients with non-COVID-19 ARDS. The historical comparison group was age and sex matched.
RESULTS
Differences in Po2 to fraction of inspired oxygen ratios between the COVID-19 ARDS group (n = 41) and the non-COVID-19 ARDS group (n = 6) during the first 7 days of prone positioning were significant at the end of prone positioning on day 1 (P = .01), day 3 (P = .04), and day 4 (P = .04). Wilcoxon signed-rank tests showed that prone positioning had a positive impact on Po2 to fraction of inspired oxygen ratios from day 1 through day 6 in the COVID-19 ARDS group and on day 2 in the non-COVID-19 ARDS group.
CONCLUSION
This retrospective review found greater improvement in oxygenation in the COVID-19 ARDS group than in the non-COVID-19 ARDS group. This finding may be attributed to the assertive prone positioning protocol during the pandemic and teams whose skills and training were likely enhanced by the pandemic demand. Prone positioning did not affect intensive care unit length of stay or intubation days in either group.
Topics: Humans; COVID-19; Prone Position; Retrospective Studies; Respiratory Distress Syndrome; Oxygen; Respiration, Artificial
PubMed: 38035620
DOI: 10.4037/ccn2023807 -
Cureus Jan 2024Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural... (Review)
Review
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
PubMed: 38361721
DOI: 10.7759/cureus.52330 -
Anesthesiology Dec 2023Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in...
BACKGROUND
Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast-enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position.
METHODS
Eleven mechanically ventilated (VT 8 ml · kg-1) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.5 ml · kg-1) to invoke lung injury. Electrical impedance tomography and computed tomography perfusion images were obtained at 2 h (early injury) and 24 h (late injury) after injury in supine position with PEEP 5 and 10 cm H2O. In eight animals, electrical impedance tomography and computed tomography perfusion imaging were also conducted in the prone position. Electrical impedance tomography perfusion (QEIT) and computed tomography perfusion (QCT) values (as percentages of image total) were compared in eight vertical regions across injury stages, levels of PEEP, and body positions using mixed-effects linear regression. The primary outcome was agreement between QEIT and QCT, defined using limits of agreement and Pearson correlation coefficient.
RESULTS
Pao2/Fio2 decreased over the course of the experiment (healthy to early injury, -253 [95% CI, -317 to -189]; early to late injury, -88 [95% CI, -151 to -24]). The limits of agreement between QEIT and QCT were -4.66% and 4.73% for the middle 50% quantile of average regional perfusion, and the correlation coefficient was 0.88 (95% CI, 0.86 to 0.90]; P < 0.001). Electrical impedance tomography and computed tomography showed similar perfusion redistributions over injury stages and in response to increased PEEP. QEIT redistributions after positional therapy underestimated QCT in ventral regions and overestimated QCT in dorsal regions.
CONCLUSIONS
Electrical impedance tomography closely approximated computed tomography perfusion measures in experimental acute respiratory distress syndrome, in the supine position, over injury progression and with increased PEEP. Further validation is needed to determine the accuracy of electrical impedance tomography in measuring perfusion redistributions after positional changes.
Topics: Male; Female; Swine; Animals; Electric Impedance; Tomography, X-Ray Computed; Respiratory Distress Syndrome; Lung; Perfusion; Tomography
PubMed: 37566686
DOI: 10.1097/ALN.0000000000004731