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Journal of Spine Surgery (Hong Kong) Sep 2023Lateral access lumbar interbody fusion is an increasingly popular procedure that allows for anterior column support through discectomy, endplate preparation, and... (Review)
Review
BACKGROUND AND OBJECTIVE
Lateral access lumbar interbody fusion is an increasingly popular procedure that allows for anterior column support through discectomy, endplate preparation, and interbody insertion. This procedure was initially described and performed with the patient in the lateral decubitus position. This would typically be followed by repositioning the patient to the prone position for pedicle screw fixation. Increasingly common is the lateral access lumbar interbody fusion in the prone position. This narrative review seeks to summarize the available literature on advantages, disadvantages, and unique features of the prone position lateral access lumbar interbody fusion.
METHODS
We performed a narrative review of articles published up to 01 November 2022 through a PubMed search. The search terms "prone lateral spine surgery" and "lateral approach spine surgery" AND "prone position" were used. Articles not available in English were excluded. The search result abstracts were independently reviewed by 2 authors and 28 full text articles were reviewed. Both reviewing authors were orthopedic surgery chief residents.
KEY CONTENT AND FINDINGS
There are several unique advantages as well as disadvantages to the prone position lateral interbody fusion. Some advantages include ease of placing pedicle screws, simultaneous posterior and lateral access, greater ease in achieving segmental lumbar lordosis, and a relatively safer positioning of the psoas muscle, lumbar plexus, and abdominal structures. Disadvantages include more difficulties with exposure and retraction, as well as visualization, positioning and ergonomics of surgery.
CONCLUSIONS
Prone position lateral interbody fusion is an increasingly prevalent and useful surgical technique with several advantages and disadvantages when compared to lateral interbody fusion in the lateral decubitus position. There are several surgical indications and goals for which prone lateral interbody fusion may provide significant benefit when compared to other interbody fusion techniques.
PubMed: 37841787
DOI: 10.21037/jss-23-34 -
Journal of Critical Care Dec 2023Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients... (Review)
Review
BACKGROUND
Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios.
METHODS
An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.
RESULTS
The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19.
CONCLUSION
APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.
Topics: Humans; COVID-19; Prone Position; Wakefulness; Oxygen; Respiratory Insufficiency
PubMed: 37639921
DOI: 10.1016/j.jcrc.2023.154401 -
Critical Care (London, England) Aug 2023The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure.
METHODS
Fifteen patients with acute hypoxemic respiratory failure and PaO/FiO < 200 mmHg underwent high-flow nasal oxygen for 1 h in supine position and 2 h in prone position, followed by a final 1-h supine phase. At the end of each study phase, the following parameters were measured: arterial blood gases, inspiratory effort (ΔP), transpulmonary driving pressure (ΔP), respiratory rate and esophageal pressure simplified pressure-time product per minute (sPTP) by esophageal manometry, tidal volume (V), end-expiratory lung impedance (EELI), lung compliance, airway resistance, time constant, dynamic strain (V/EELI) and pendelluft extent through electrical impedance tomography.
RESULTS
Compared to supine position, prone position increased PaO/FiO (median [Interquartile range] 104 mmHg [76-129] vs. 74 [69-93], p < 0.001), reduced respiratory rate (24 breaths/min [22-26] vs. 27 [26-30], p = 0.05) and increased ΔP (12 cmHO [11-13] vs. 9 [8-12], p = 0.04) with similar sPTP (131 [75-154] cmHO s min vs. 105 [81-129], p > 0.99) and ΔP (9 [7-11] cmHO vs. 8 [5-9], p = 0.17). Airway resistance and time constant were higher in prone vs. supine position (9 cmHO s arbitrary units [4-11] vs. 6 [4-9], p = 0.05; 0.53 s [0.32-61] vs. 0.40 [0.37-0.44], p = 0.03). Prone position increased EELI (3887 arbitrary units [3414-8547] vs. 1456 [959-2420], p = 0.002) and promoted V distribution towards dorsal lung regions without affecting V size and lung compliance: this generated lower dynamic strain (0.21 [0.16-0.24] vs. 0.38 [0.30-0.49], p = 0.004). The magnitude of pendelluft phenomenon was not different between study phases (55% [7-57] of V in prone vs. 31% [14-55] in supine position, p > 0.99).
CONCLUSIONS
Prone position improves oxygenation, increases EELI and promotes V distribution towards dependent lung regions without affecting V size, ΔP, lung compliance and pendelluft magnitude. Prone position reduces respiratory rate and increases ΔP because of positional increases in airway resistance and prolonged expiratory time. Because high ΔP is the main mechanistic determinant of self-inflicted lung injury, caution may be needed in using awake prone position in patients exhibiting intense ΔP. Clinical trail registeration: The study was registered on clinicaltrials.gov (NCT03095300) on March 29, 2017.
Topics: Humans; Prone Position; Respiration; Respiratory Insufficiency; Tidal Volume; Wakefulness; Cross-Over Studies
PubMed: 37592288
DOI: 10.1186/s13054-023-04600-9 -
European Respiratory Review : An... Jun 2023Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019... (Review)
Review
Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.
Topics: Humans; COVID-19; Wakefulness; Prone Position; Respiratory Insufficiency; Lung; Respiratory Distress Syndrome; Patient Positioning
PubMed: 37137508
DOI: 10.1183/16000617.0245-2022 -
Journal of Clinical Medicine Oct 2023It is well known by surgeons that patient positioning is fundamental to exposing the organs when performing an operation via laparoscopy, as gravity can help move the... (Review)
Review
It is well known by surgeons that patient positioning is fundamental to exposing the organs when performing an operation via laparoscopy, as gravity can help move the organs and facilitate the exposure of the surgical site. But is it also important for endoscopic procedures? This paper examines various types of endoscopic operations and addresses the issue of the patient's position. The patient's position can be changed not only by rotating the patient along the head-toe axis but also by tilting the surgical bed, as is undertaken during laparoscopic surgical procedures. In particular, it is useful to take into account the effect of gravity on lesion exposure, tumour traction during dissection, crushing by body weight, risk of sample drop, risk of damage to adjacent organs, and anatomical exposure for procedures with radiological support. The endoscopist should always keep in mind the patient's anatomy and the position of the endoscope during operative procedures, not limited to considering only intraluminal vision.
PubMed: 37959286
DOI: 10.3390/jcm12216822 -
Journal of Minimal Access Surgery 2023Standard minimally invasive Ivor Lewis oesophagectomy is performed through a multiport technique using carbon dioxide. However, access to video-assisted thoracoscopic...
Standard minimally invasive Ivor Lewis oesophagectomy is performed through a multiport technique using carbon dioxide. However, access to video-assisted thoracoscopic surgery (VATS) is increasingly shifting to a single-port approach due to its proven safety and efficacy in lung surgeries. Therefore, the preamble of this submission is to describe, 'How I do differently' uniportal VATS MIO in three major steps: (a) VATS dissection through a single 4-cm incision in a semi-prone position without artificial capnothorax; (b) fluorescence dye to check conduit perfusion and (c) intrathoracic overlay anastomosis with a linear stapler.
PubMed: 37282442
DOI: 10.4103/jmas.jmas_356_22 -
Journal of Applied Clinical Medical... Dec 2023To probe the differences of dosimetry and acute radiation enteritis between prone and supine position in gynecological cancer patients treated with intensity-modulate...
PURPOSE
To probe the differences of dosimetry and acute radiation enteritis between prone and supine position in gynecological cancer patients treated with intensity-modulate radiotherapy (IMRT).
METHODS
Gynecologic tumor patients who received IMRT from January 2020 to July 2021 were analyzed. 60 patients were enrolled and divided into the supine or prone position group according to different radiotherapy positions, including 34 patients in prone position and 26 patients in supine position. The dose-volume histogram of organs at risk (OARs) and the incidence of acute radiation enteritis were compared between the two groups. Multivariate logistic regression analysis was conducted to show the clinical characteristics and dose volume metrics to the association of acute radiation enteritis.
RESULTS
The percentage of volume receiving 5 Gy, 10 Gy, 15 Gy, 20 Gy, 30 Gy, 40 Gy, and 45 Gy doses for the small intestine were 79.0%, 67.4%, 59.6%, 44.3%, 17.0%, 8.9%, and 6.0%, respectively in the prone group, which were lower than those in the supine group (P < 0.05). The mean radiation dose (D ) of the small intestine exposure in prone group was decreased (P < 0.001). Compared with the supine group, the prone group who suffered from acute radiation enteritis were much less. The probability of indigestion, nausea, vomiting, diarrhea, and abdominal pain in the prone position were 35.29%, 29.41%, 17.65%, 38.24%, and 5.88%, respectively. The differences in indigestion, nausea, and diarrhea between the two groups were statistically significant (P = 0.012, P = 0.029, and P = 0.041). Multivariate logistic regression analysis was shown that prone position was found to be protective against indigestion (P = 0.002), nausea (P = 0.013), vomiting (P = 0.035), and abdominal pain (P = 0.021).
CONCLUSION
Prone position in IMRT for gynecological cancers could significantly reduce radiation dose to the small bowel and colon, which would decrease the occurrence and severity of acute intestinal side effects possibly.
Topics: Humans; Female; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Supine Position; Dyspepsia; Prone Position; Enteritis; Radiotherapy Planning, Computer-Assisted; Genital Neoplasms, Female; Diarrhea; Abdominal Pain; Nausea; Vomiting
PubMed: 37621141
DOI: 10.1002/acm2.14135 -
Molecules (Basel, Switzerland) Oct 2023Acne vulgaris stands out as the most prevalent skin disorder among teenagers and young adults, causing physical discomfort and considerable economic and psychological... (Review)
Review
Acne vulgaris stands out as the most prevalent skin disorder among teenagers and young adults, causing physical discomfort and considerable economic and psychological burdens on individuals and society. A wide range of topical and systemic therapies are available in acne treatment. Chemical peeling is a skin resurfacing technique designed to rebuild healthy skin using exfoliating substances, a simple and affordable process with various dermatological uses. Chemical peels, classified as superficial, medium, and deep, have been utilized for acne vulgaris and multiple other skin issues. In these chemical peels, a diverse range of chemical substances is employed, each with its unique mode of action. Among these, α-hydroxy and β-hydroxy acids have gathered attention for their efficacy in reducing acne lesions and enhancing overall skin appearance. Acids, such as salicylic acid, glycolic acid, or lactic acid, are commonly used in chemical peels due to their exfoliating and sebum-regulating properties. Despite the widespread use of these acids, there exists a lack of consensus regarding the most effective acid type and concentration for treating acne-prone skin. This review aims to bridge this knowledge gap by evaluating the effectiveness and safety of various organic acids used in chemical peels specifically for acne-prone skin. The findings of this comprehensive bibliographic review indicate that organic acid-based chemical peels represent effective and safe treatment options for individuals with acne-prone skin. Their adaptability sets these treatments apart; the choice of organic acid can be tailored to meet individual patient needs and tolerability levels. This personalized approach ensures that patients receive optimal care while minimizing the risks associated with the treatment. As research in this field progresses, it is anticipated that a more nuanced understanding of the ideal acid type and concentration will emerge, further enhancing the efficacy and safety of chemical peels for acne-prone skin.
Topics: Adolescent; Young Adult; Humans; Keratolytic Agents; Acne Vulgaris; Salicylic Acid; Chemexfoliation; Skin
PubMed: 37894698
DOI: 10.3390/molecules28207219