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Critical Care Explorations Oct 2023Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory...
OBJECTIVES
Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients.
DESIGN
A prospective cohort study.
PATIENTS
Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia.
INTERVENTIONS
Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm HO to 6 cm HO in supine and prone positions.
MEASUREMENTS
Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions.
MAIN RESULTS
Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients ( = 13), of which the Crs decreased in 32% ( = 7) and increased in 27% ( = 6). To reach maximum Crs after pronation, PEEP was changed in 45% of the patients by at least 4 cm HO. After pronation, the ventilation and compliance of the dorsal region did not consistently change in the entire sample of patients, increasing specifically in a subgroup of patients who showed a positive change in Crs when transitioning from supine to prone position. These combined changes in ventilation and compliance suggest dorsal recruitment postpronation. In addition, the subgroup with increased Crs postpronation demonstrated the most pronounced difference between dorsal and ventral ventilation distribution from supine to prone position ( = 0.01), indicating heterogeneous ventilation distribution in prone position.
CONCLUSIONS
Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.
PubMed: 37795456
DOI: 10.1097/CCE.0000000000000983 -
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 -
The Journal of International Medical... Aug 2023To test agreement and interchangeability between distal (dRA) and forearm radial arterial (RA) pressures (AP) during general anesthesia (GA) for prone spinal surgery. (Observational Study)
Observational Study
OBJECTIVE
To test agreement and interchangeability between distal (dRA) and forearm radial arterial (RA) pressures (AP) during general anesthesia (GA) for prone spinal surgery.
METHODS
This prospective observational study involved 40 patients scheduled for GA spinal surgery. The right dRA and left forearm RA were cannulated in all patients to continuously measure invasive blood pressures (IBP). We compared the agreement and trending ability of systolic AP (SAP), diastolic AP (DAP), and mean AP (MAP) at each site 15 minutes after tracheal intubation, start of surgery, 30 and 60 minutes after the start of surgery, and after skin suturing.
RESULTS
Paired BP values (n = 184) (37 cases) were analyzed. The bias (standard deviation), limits of agreement, and percentage error were: SAP: 0.19 (3.03), -5.75 to 6.12, and 5.04%; DAP: -0.06 (1.75), -3.50 to 3.38, and 5.10%; and MAP: 0.08 (1.52), -2.90 to 3.05, and 3.54%, respectively. The linear regression coefficients of determination were 0.981, 0.982, and 0.988 for SAPs, DAPs, and MAPs, respectively; four-quadrant plot concordance rates were 95.11%, 92.03%, and 92.66%, respectively.
CONCLUSION
All arterial BPs showed good agreement and trending capabilities for both the dRA and RA. The dRA may be substituted for the RA in IBP monitoring.
Topics: Humans; Forearm; Arterial Pressure; Prospective Studies; Upper Extremity; Arteries
PubMed: 37646630
DOI: 10.1177/03000605231188285 -
Journal of Behavior Therapy and... Dec 2023CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance...
BACKGROUND AND OBJECTIVES
CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance CBT for bipolar disorder with imagery techniques, research is needed into emotional imagery quality and, related appraisals of imagery and their relationships with mood instability and subsequent behaviour in bipolar disorder.
METHODS
Patients with bipolar disorder (n = 106), unipolar depression (n = 51), creative imagery prone participants (n = 53) and participants without a history of a mood disorder (n = 135) completed the Dutch Imagery Survey (DImS), an online imagery survey, adapted from the Imagery Interview, assessing self-reported emotional imagery aspects. Imagery quality, appraisals and their self-perceived effects on emotion and behaviour were compared between groups. As unexpected differences within the bipolar group appeared, these were additionally explored.
RESULTS
Imagery appraisals but not imagery quality discriminated between the patient groups and non-patient groups Imagery was perceived as an emotional amplifier in all groups, but this was specifically apparent in bipolar manic and bipolar depressed groups. Only in the bipolar group imagery was experienced to amplify behavioural tendencies.
LIMITATIONS
Results need to be replicated using a larger sample of patients with BD who are currently manic or depressed.
CONCLUSIONS
Not only quality of imagery, but especially appraisals associated with imagery are differentiating between imagery prone people with and without mood disorder. Imagery amplifies emotion in all groups, but only in those patients with bipolar disorder currently manic or depressed did this influence behaviour.
Topics: Humans; Bipolar Disorder; Self Report; Emotions; Mood Disorders; Depressive Disorder
PubMed: 37182427
DOI: 10.1016/j.jbtep.2023.101861 -
Journal of Clinical Medicine Jun 2024: Anterior lumbar interbody fusion (ALIF) and posterior spinal fusion (PSF) play pivotal roles in restoring lumbar lordosis in spinal surgery. There is an ongoing debate...
: Anterior lumbar interbody fusion (ALIF) and posterior spinal fusion (PSF) play pivotal roles in restoring lumbar lordosis in spinal surgery. There is an ongoing debate between combined single-position surgery and traditional prone-position PSF for optimizing segmental lumbar lordosis. : This retrospective study analyzed 59 patients who underwent ALIF in the supine position followed by PSF in the prone position at a single institution. Cobb angles were measured preoperatively, post-ALIF, and post-PSF using X-ray imaging. One-way repeated measures ANOVA and post-hoc analyses with Bonferroni adjustment were employed to compare mean Cobb angles at different time points. Cohen's d effect sizes were calculated to assess the magnitude of changes. Sample size calculations were performed to ensure statistical power. : The mean segmental Cobb angle significantly increased from preoperative (32.2 ± 13.8 degrees) to post-ALIF (42.2 ± 14.3 degrees, Cohen's d: -0.71, < 0.0001) and post-PSF (43.6 ± 14.6 degrees, Cohen's d: -0.80, < 0.0001). There was no significant difference between Cobb angles after ALIF and after PSF (Cohen's d: -0.10, = 0.14). The findings remained consistent when Cobb angles were analyzed separately for single-screw and double-screw ALIF constructs. : Both supine ALIF and prone PSF significantly increased segmental lumbar lordosis compared to preoperative measurements. The negligible difference between post-ALIF and post-PSF lordosis suggests that supine ALIF followed by prone PSF can be an effective approach, providing flexibility in surgical positioning without compromising lordosis improvement.
PubMed: 38930084
DOI: 10.3390/jcm13123555 -
Cureus Mar 2024This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in... (Review)
Review
This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.
PubMed: 38686225
DOI: 10.7759/cureus.57247 -
Frontiers in Endocrinology 2023Ketosis-prone type 2 diabetes (KPD), as a unique emerging clinical entity, often has no clear inducement or obvious clinical symptoms at the onset of the disease....
BACKGROUND
Ketosis-prone type 2 diabetes (KPD), as a unique emerging clinical entity, often has no clear inducement or obvious clinical symptoms at the onset of the disease. Failure to determine ketosis in time may lead to more serious consequences and even death. Therefore, our study aimed to develop and validate a novel nomogram to predict KPD.
METHODS
In this retrospective study, clinical data of a total of 398 newly diagnosed type 2 diabetes in our hospital who met our research standards with an average age of 48.75 ± 13.86 years years old from January 2019 to December 2022 were collected. According to the occurrence of ketosis, there were divided into T2DM groups(228 cases)with an average age of 52.19 ± 12.97 years, of whom 69.74% were male and KPD groups (170cases)with an average age of 44.13 ± 13.72 years, of whom males account for 80.59%. Univariate and multivariate logistic regression analysis was performed to identify the independent influencing factors of KPD and then a novel prediction nomogram model was established based on these independent predictors visually by using R4.3. Verification and evaluation of predictive model performance comprised receiver-operating characteristic (ROC) curve, corrected calibration curve, and clinical decision curve (DCA).
RESULTS
4 primary independent predict factors of KPD were identified by univariate and multivariate logistic regression analysis and entered into the nomogram including age, family history, HbA1c and FFA. The model incorporating these 4 predict factors displayed good discrimination to predict KPD with the area under the ROC curve (AUC) of 0.945. The corrected calibration curve of the nomogram showed good fitting ability with an average absolute error =0.006 < 0.05, indicating a good accuracy. The decision analysis curve (DCA) demonstrated that when the risk threshold was between 5% and 99%, the nomogram model was more practical and accurate.
CONCLUSION
In our novel prediction nomogram model, we found that age, family history, HbA1c and FFA were the independent predict factors of KPD. The proposed nomogram built by these 4 predictors was well developed and exhibited powerful predictive performance for KPD with high discrimination, good accuracy, and potential clinical applicability, which may be a useful tool for early screening and identification of high-risk population of KPD and therefore help clinicians in making customized treatment strategy.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Nomograms; Retrospective Studies; Diabetes Mellitus, Type 1; Ketosis
PubMed: 37829685
DOI: 10.3389/fendo.2023.1235048 -
Diagnostics (Basel, Switzerland) Jul 2023Prone position is useful in reducing respiratory motion artifacts in lung nodules on 2-Deoxy-2-[F] fluoro-D-glucose ([F]FDG) positron emission tomography/computed...
Prone position is useful in reducing respiratory motion artifacts in lung nodules on 2-Deoxy-2-[F] fluoro-D-glucose ([F]FDG) positron emission tomography/computed tomography (PET/CT). However, whether prone position PET/CT is useful in evaluating hepatic lesions is unknown. Thirty-five hepatic lesions from 20 consecutive patients were evaluated. The maximum standardized uptake value (SUV) and metabolic tumor volume (MTV) of both standard supine position PET/CT and additional prone position PET/CT were evaluated. No significant difference in SUV (4.41 ± 2.0 vs. 4.23 ± 1.83; = 0.240) and MTV (5.83 ± 6.69 vs. 5.95 ± 6.24; = 0.672) was observed between supine position PET/CT and prone position PET/CT. However, SUV changes in prone position PET/CT varied compared with those in supine position PET/CT (median, -4%; range: -30-71%). Prone position PET/CT was helpful when [F]FDG uptake of the hepatic lesions was located outside the liver on supine position PET/CT ( = 4, SUV change: median 15%; range: 7-71%) and there was more severe blurring on supine position PET/CT ( = 6, SUV change: median 11%; range: -3-32%). Unlike in lung nodules, prone position PET/CT is not always useful in evaluating hepatic lesions, but it may be helpful in individual cases such as hepatic dome lesions.
PubMed: 37568906
DOI: 10.3390/diagnostics13152539 -
Scientific Reports Nov 2023High-rate GNSS has been proven effective in characterising waveforms and co-seismic displacements due to medium-to-strong natural earthquakes. No application focused on...
High-rate GNSS has been proven effective in characterising waveforms and co-seismic displacements due to medium-to-strong natural earthquakes. No application focused on small magnitude events like shallow anthropogenic earthquakes, where displacements and noise have the same order of magnitude. We propose a procedure based on proper signal detection and filtering of the position and velocity time series obtained from high-rate (10 Hz) GNSS data processing with two intrinsically different approaches (Precise Point Positioning and variometry). We tested it on five mining tremors with magnitudes of 3.4-4.0, looking both at event detection and its kinematic characterisation. Here we show a high agreement, at the level of 1 s, between GNSS and seismic solutions for the earthquake first epoch detection. Also, we show that high-rate multi-constellation (GPS + Galileo) GNSS can reliably characterise low-magnitude shallow earthquakes in terms of induced displacements and velocities, and, including their peak values, respectively, at the level of very few millimetres and 1-2 cm/s, paving the way to the routine use of GNSS-seismology for monitoring human activities prone to cause small earthquakes and related potential damages.
PubMed: 38017025
DOI: 10.1038/s41598-023-47964-2