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Neurosurgery Clinics of North America Oct 2023The lateral transpsoas approach has become fundamental to minimally invasive spine surgery. The large interbody grafts that can be placed through this approach allow for... (Review)
Review
The lateral transpsoas approach has become fundamental to minimally invasive spine surgery. The large interbody grafts that can be placed through this approach allow for robust arthrodesis of the anterior column, indirect decompression, and restoration of lordosis without disrupting the posterior musculature or ligamentous structures. The lateral decubitus position has traditionally been used for this approach but the prone position has gained popularity because it can reduce operating times for patients who also require posterior pedicle screw fixation. The transpsoas approach can be effectively performed in either position but surgeons should know the nuances that distinguish them.
Topics: Animals; Humans; Lumbar Vertebrae; Lordosis; Lumbosacral Region; Pedicle Screws
PubMed: 37718107
DOI: 10.1016/j.nec.2023.06.008 -
Alternative Therapies in Health and... Nov 2023Assessing the safety and efficacy of enteral nutrition in critically ill patients receiving prone position ventilation is essential to optimize treatment strategies for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Assessing the safety and efficacy of enteral nutrition in critically ill patients receiving prone position ventilation is essential to optimize treatment strategies for critically ill patients. Systematically evaluate the effectiveness and safety of prone position enteral nutrition in critically ill ventilated patients, providing a reference for clinical decision-making.
METHODS
We conducted a comprehensive search for relevant studies on the safety and efficacy of enteral nutrition in prone ventilation patients. Our search encompassed randomized controlled trials, quasi-experimental studies, and cohort studies, utilizing databases including PubMed, Embase, and Scopus. The search duration spanned from May 2000 to May 2023. Inclusion and exclusion criteria were applied to select eligible literature, followed by data extraction and quality assessment. We employed specific keywords and filters in our search strategy to ensure a robust selection of studies. Subsequently, statistical analysis was performed utilizing RevMan 5.2 software to synthesize and interpret the findings effectively.
RESULT
Five articles were ultimately included, with a total of 372 patients undergoing prone ventilation. The meta-analysis results showed that patients receiving enteral nutrition during prone and supine ventilation had higher levels of gastric residue incidence [RR = -0.01, 95% CI: (-0.08, 0.06), P = .77]. There was no significant difference in the incidence of vomiting/reflux between the prone position group and the control group [RR = 0.60, 95%CI: (0.15-2.45), P = .48]. Prone position ventilation had no significant effect on the incidence of ventilator-associated pneumonia (VAP) [RR = 1.00, 95%CI: (0.14-6.90), P = 1.00]. There was no significant difference in the rate of enteral nutrition interruption between the prone position group and the control group [RR = 0.65, 95%CI: (0.28-1.52), P = .32].
CONCLUSION
Enteral nutrition in critically ill patients receiving prone position ventilation was not associated with high levels of gastric residual, vomiting or reflux, ventilator-associated pneumonia, or increased incidence of enteral nutrition interruption.
Topics: Humans; Pneumonia, Ventilator-Associated; Respiration, Artificial; Critical Illness; Enteral Nutrition; Intensive Care Units; Vomiting
PubMed: 37708547
DOI: No ID Found -
Journal of Wound Care Aug 2023To determine the incidence of pressure injuries (PIs) and their impact on clinical outcomes in patients treated with prone positioning for COVID-19 acute respiratory...
OBJECTIVE
To determine the incidence of pressure injuries (PIs) and their impact on clinical outcomes in patients treated with prone positioning for COVID-19 acute respiratory distress syndrome (ARDS).
METHOD
All patients with COVID-19 ARDS who were treated with prone positioning were categorised as cases and those who were not treated with prone positioning were categorised as controls. Demographics, clinical data and confounding variables affecting outcomes were recorded. Outcome variables of mortality and length of stay in intensive care units (ICUs) for both groups were recorded. Both groups' incidence of PIs were recorded and compared using statistical tests. Fisher's exact test was used for categorical variables, and Mann-Whitney U test was used for continuous variables.
RESULTS
The sample included 212 patients, treated with prone position (n=104) and without prone treatment (n=108). The incidence of PIs was n=75 (35.4%). PIs were significantly higher in patients in the prone position (n=51, 49%) compared with patients who were not (n=24, 22%); p=0.001. Patients in the prone position were found to have lower APACHE-2 scores, longer stays on the ventilator, ICU and in the hospital.
CONCLUSION
PIs are more prevalent in patients in the prone position and it adversely impacts clinical outcomes; it prolongs the length of stay on the ventilator, in the ICU and in the hospital.
Topics: Humans; Prone Position; Pressure Ulcer; Incidence; COVID-19; Respiratory Distress Syndrome; Respiration, Artificial
PubMed: 37572338
DOI: 10.12968/jowc.2023.32.8.500 -
Prilozi (Makedonska Akademija Na... Jul 2023: Posterior tibial plateau fractures are a rare type of fractures. Most surgeons are accustomed to operate in the supine position, however, surgery in the posterior knee...
: Posterior tibial plateau fractures are a rare type of fractures. Most surgeons are accustomed to operate in the supine position, however, surgery in the posterior knee region and operating in prone position can be challenging because of the presence of neurovascular structures including the tibial nerve, popliteal artery and vein, common peroneal nerve and, also challenging to achieve effective reduction and fixation, thus, it is less commonly performed. : Between February and September 2022 four posterior tibial plateau fractures were diagnosed and operated in our clinic within a six months follow-up (2 female and 2 male with mean age of 48.5 years). All were diagnosed with X-rays and CT scans. All of the fractures were on the right leg. Posterior "S shape" approach in prone position was used to reduce the tibial condyle and fix it with a plate. In fracture patterns that include lateral plateau impressions, the posterior "S shape" approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach was made and additional locking plate was placed. Radiographic evaluation included reduction quality and satisfactory alignment of the bone axis. : All fractures healed within 6 months, without secondary displacement. Throughout the follow-up period, there were no incidences of post-traumatic osteoarthritis of the knee. No patient complained of knee instability. : The direct dorsal approach allowed for adequate open reduction and internal fixation, and early clinical results are promising. However, in fracture patterns that include lateral plateau impressions, the posterior "S shape" approach may not be sufficient to perform open reduction and internal fixation of the lateral condyle, so an additional anterolateral approach should be made and additional locking plate to be placed.
Topics: Humans; Male; Female; Middle Aged; Tibial Plateau Fractures; Treatment Outcome; Tibial Fractures; Radiography; Tomography, X-Ray Computed; Fracture Fixation, Internal
PubMed: 37453125
DOI: 10.2478/prilozi-2023-0028 -
Journal of Neurosurgery. Spine Sep 2023Lateral lumbar interbody fusion (LLIF) is a workhorse surgical approach for lumbar arthrodesis. There is growing interest in techniques for performing single-position...
OBJECTIVE
Lateral lumbar interbody fusion (LLIF) is a workhorse surgical approach for lumbar arthrodesis. There is growing interest in techniques for performing single-position surgery in which LLIF and pedicle screw fixation are performed with the patient in the prone position. Most studies of prone LLIF are of poor quality and without long-term follow-up; therefore, the complication profile related to this novel approach is not well known. The objective of this study was to perform a systematic review and pooled analysis to understand the safety profile of prone LLIF.
METHODS
A systematic review of the literature and a pooled analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting prone LLIF were assessed for inclusion. Studies not reporting complication rates were excluded.
RESULTS
Ten studies meeting the inclusion criteria were analyzed. Overall, 286 patients were treated with prone LLIF across these studies, and a mean (SD) of 1.3 (0.2) levels per patient were treated. The 18 intraoperative complications reported included cage subsidence (3.8% [3/78]), anterior longitudinal ligament rupture (2.3% [5/215]), cage repositioning (2.1% [2/95]), segmental artery injury (2.0% [5/244]), aborted prone interbody placement (0.8% [2/244]), and durotomy (0.6% [1/156]). No major vascular or peritoneal injuries were reported. Sixty-eight postoperative complications occurred, including hip flexor weakness (17.8% [21/118]), thigh and groin sensory symptoms (13.3% [31/233]), revision surgery (3.8% [3/78]), wound infection (1.9% [3/156]), psoas hematoma (1.3% [2/156]), and motor neural injury (1.2% [2/166]).
CONCLUSIONS
Single-position LLIF in the prone position appears to be a safe surgical approach with a low complication profile. Longer-term follow-up and prospective studies are needed to better characterize the long-term complication rates related to this approach.
Topics: Humans; Lumbar Vertebrae; Postoperative Complications; Spinal Fusion; Reoperation; Vascular System Injuries; Retrospective Studies
PubMed: 37310041
DOI: 10.3171/2023.4.SPINE221180 -
Frontiers in Physiology 2023. Global and regional transpulmonary pressure (P) during one-lung ventilation (OLV) is poorly characterized. We hypothesized that global and regional P and driving P...
. Global and regional transpulmonary pressure (P) during one-lung ventilation (OLV) is poorly characterized. We hypothesized that global and regional P and driving P (ΔP) increase during protective low tidal volume OLV compared to two-lung ventilation (TLV), and vary with body position. . In sixteen anesthetized juvenile pigs, intra-pleural pressure sensors were placed in ventral, dorsal, and caudal zones of the left hemithorax by video-assisted thoracoscopy. A right thoracotomy was performed and lipopolysaccharide administered intravenously to mimic the inflammatory response due to thoracic surgery. Animals were ventilated in a volume-controlled mode with a tidal volume (V) of 6 mL kg during TLV and of 5 mL kg during OLV and a positive end-expiratory pressure (PEEP) of 5 cmHO. Global and local transpulmonary pressures were calculated. Lung instability was defined as end-expiratory P<2.9 cmHO according to previous investigations. Variables were acquired during TLV (TLVsupine), left lung ventilation in supine (OLVsupine), semilateral (OLVsemilateral), lateral (OLVlateral) and prone (OLVprone) positions randomized according to Latin-square sequence. Effects of position were tested using repeated measures ANOVA. . End-expiratory P and ΔP were higher during OLVsupine than TLVsupine. During OLV, regional end-inspiratory P and ΔP did not differ significantly among body positions. Yet, end-expiratory P was lower in semilateral (ventral: 4.8 ± 2.9 cmHO; caudal: 3.1 ± 2.6 cmHO) and lateral (ventral: 1.9 ± 3.3 cmHO; caudal: 2.7 ± 1.7 cmHO) compared to supine (ventral: 4.8 ± 2.9 cmHO; caudal: 3.1 ± 2.6 cmHO) and prone position (ventral: 1.7 ± 2.5 cmHO; caudal: 3.3 ± 1.6 cmHO), mainly in ventral ( ≤ 0.001) and caudal ( = 0.007) regions. Lung instability was detected more often in semilateral (26 out of 48 measurements; = 0.012) and lateral (29 out of 48 measurements, < 0.001) as compared to supine position (15 out of 48 measurements), and more often in lateral as compared to prone position (19 out of 48 measurements, = 0.027). . Compared to TLV, OLV increased lung stress. Body position did not affect stress of the ventilated lung during OLV, but lung stability was lowest in semilateral and lateral decubitus position.
PubMed: 37601645
DOI: 10.3389/fphys.2023.1204531 -
World Neurosurgery Aug 2023The aim of this study was to investigate the changes in spine-pelvis sagittal parameters from the standing position to the prone position and to study the relationship...
Sagittal Spinopelvic Alignment in the Standing and Prone Positions of Patients with Old Traumatic Thoracolumbar Kyphosis: Relationship with Immediately Postoperative Parameters.
OBJECTIVE
The aim of this study was to investigate the changes in spine-pelvis sagittal parameters from the standing position to the prone position and to study the relationship between sagittal parameters and immediately postoperative parameters.
METHODS
Thirty-six patients with old traumatic spinal fracture combined with kyphosis were enrolled. The preoperative standing position, prone position, and postoperative sagittal parameters of the spine and pelvis, including the local kyphosis Cobb angle (LKCA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope (SS), pelvic tilt (PT), pelvic incidence minus lumbar lordosis angle (PI-LLA), and sagittal vertebral axis (SVA), were measured. The data of kyphotic flexibility and correction rate werecollected and analyzed. The parameters of the preoperative standing position, prone position and postoperative sagittal position were analyzed statistically. Correlation analysis and regression analysis of the preoperative standing and prone sagittal parameters and postoperative parameters were conducted.
RESULTS
There were significant differences in the preoperative standing position, prone position, and postoperative LKCA and TK. Correlation analysis showed that preoperative sagittal parameters of the standing position and prone position were all correlated with postoperative homogeneity. Flexibility was not related to the correction rate. Regression analysis showed preoperative standing, prone LKCA, and TK were linear with postoperative standing.
CONCLUSIONS
The LKCA and TK of old traumatic kyphosis obviously changed from the standing position to the prone position, which were linear with postoperative LKCA and TK and can be used to predict postoperative sagittal parameters. This change should be taken into account in the surgical strategy.
Topics: Humans; Lordosis; Standing Position; Prone Position; Thoracic Vertebrae; Kyphosis; Fractures, Bone; Lumbar Vertebrae; Retrospective Studies
PubMed: 37295468
DOI: 10.1016/j.wneu.2023.05.121 -
Surgical Endoscopy Oct 2023Conventional supine emergence and prone extubation from general endotracheal anesthesia (GEA) are associated with extubation-related adverse events (ERAEs). Given the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Conventional supine emergence and prone extubation from general endotracheal anesthesia (GEA) are associated with extubation-related adverse events (ERAEs). Given the minimally invasive nature of endoscopic retrograde cholangiopancreatography (ERCP) as well as the improved ventilation/perfusion matching and easier airway opening in the prone position, we aimed to assess the safety of prone emergence and extubation in patients undergoing ERCP under GEA.
METHODS
Totally, 242 eligible patients were recruited and randomized into the supine extubation group (n = 121; supine group) and the prone extubation group (n = 121; prone group). The primary endpoint was the incidence of ERAEs during emergence, including hemodynamic fluctuations, coughing, stridor, and hypoxemia requiring airway maneuvers. The secondary endpoints included the incidence of monitoring disconnections, extubation time, recovery time, room exit time, and post-procedure sore throat.
RESULTS
The incidence of ERAEs was significantly lower in the prone group compared with the supine group (8.3% vs 34.7%, OR = 0.17, 95% CI 0.18-0.56; P < 0.001). Moreover, the prone group demonstrated no monitoring disconnections, shorter extubation time and room exit time, faster recovery, and, lower frequency and milder sore throat after the procedure.
CONCLUSIONS
For patients undergoing ERCP under GEA, compared with supine, prone emergence, and extubation had remarkably lower rates of EAREs and better recovery, and can maintain continuous monitoring and improve efficiency.
Topics: Humans; Anesthesia, Endotracheal; Cholangiopancreatography, Endoscopic Retrograde; Anesthesia, General; Hemodynamics; Pain
PubMed: 37415015
DOI: 10.1007/s00464-023-10187-7 -
Nitric Oxide : Biology and Chemistry Jun 2024Acute respiratory distress syndrome (ARDS) is characterized by a redistribution of regional lung perfusion that impairs gas exchange. While speculative, experimental... (Review)
Review
Acute respiratory distress syndrome (ARDS) is characterized by a redistribution of regional lung perfusion that impairs gas exchange. While speculative, experimental evidence suggests that perfusion redistribution may contribute to regional inflammation and modify disease progression. Unfortunately, tools to visualize and quantify lung perfusion in patients with ARDS are lacking. This review explores recent advances in perfusion imaging techniques that aim to understand the pulmonary circulation in ARDS. Dynamic contrast-enhanced computed tomography captures first-pass kinetics of intravenously injected dye during continuous scan acquisitions. Different contrast characteristics and kinetic modeling have improved its topographic measurement of pulmonary perfusion with high spatial and temporal resolution. Dual-energy computed tomography can map the pulmonary blood volume of the whole lung with limited radiation exposure, enabling its application in clinical research. Electrical impedance tomography can obtain serial topographic assessments of perfusion at the bedside in response to treatments such as inhaled nitric oxide and prone position. Ongoing technological improvements and emerging techniques will enhance lung perfusion imaging and aid its incorporation into the care of patients with ARDS.
Topics: Humans; Respiratory Distress Syndrome; Lung; Tomography, X-Ray Computed; Pulmonary Circulation; Perfusion Imaging; Animals
PubMed: 38588918
DOI: 10.1016/j.niox.2024.04.004 -
Nursing in Critical Care Jan 2024The combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but...
BACKGROUND
The combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but its use has been limited due to potential complications.
AIM
To report the prevalence of pressure ulcers and other complications due to prone positioning in adult patients receiving veno-venous ECMO.
STUDY DESIGN
This cross-sectional study was conducted in a tertiary level intensive care unit (ICU) in Milan (Italy), between January 2015 and December 2019. The study population was critically ill adult patients undergoing veno-venous ECMO. Statistical association between pressure ulcers and the type of body positioning (prone versus supine) was explored fitting a logistic model.
RESULTS
In the study period, 114 patients were treated with veno-venous ECMO and 62 (54.4%) patients were placed prone for a total of 130 prone position cycles. ECMO cannulation was performed via femoro-femoral configuration in the majority of patients (82.4%, 94/114). Pressure ulcers developed in 57.0% of patients (95%CI: 44.0%-72.6%), most often arising on the face and the chin (37.1%, 23/62), particularly in those placed prone. The main reason of prone positioning interruption was the decrease of ECMO blood flow (8.1%, 5/62). The fitted model showed no association between body position during ECMO and occurrence of pressure ulcers (OR 1.3, 95%CI: 0.5-3.6, p = .532).
CONCLUSIONS
Facial pressure ulcers were the most frequent complications of prone positioning. Nurses should plan and implement evidence-based care to prevent such pressure injuries in patients undergoing ECMO.
RELEVANCE TO CLINICAL PRACTICE
The combination of prone positioning and ECMO shows few life-threating complications. This manoeuvre during ECMO is feasible and safe when performed by experienced ICU staff.
Topics: Adult; Humans; Extracorporeal Membrane Oxygenation; Prone Position; Cross-Sectional Studies; Pressure Ulcer; Intensive Care Units; Retrospective Studies
PubMed: 36740588
DOI: 10.1111/nicc.12889