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Management and experience of postural placement in postoperative mechanical ventilation of newborns.Annals of Palliative Medicine Jul 2020Congenital diaphragmatic hernia (CDH) is a neonatal condition that mainly occurs when the abdominal organs herniate into the thorax, obstructing the development of the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Congenital diaphragmatic hernia (CDH) is a neonatal condition that mainly occurs when the abdominal organs herniate into the thorax, obstructing the development of the lungs. Postoperative neonatal breathing disorder is one of the main causes of neonatal death. This study summarizes the postoperative nursing status of 30 cases of neonatal CDH in our hospital, and explores the effect of body position in mechanical ventilation care following CDH surgery.
METHODS
A total of 30 CHD children admitted in our hospital between June, 2018 and October, 2019 were included. The neonates were divided into preterm infant group (n=15) and full-term infant group (n=15). Each child was immediately transferred to the newborn intensive care unit (NICU) ward after surgery and received the hospital's NCIU special care. Besides routine nursing, each child was placed in a randomly selected primary position (the prone position or supine position). After 30 min, their oxygenation indexes were measured, and then their position (prone position or supine position) was changed. After 30 min, the neonates' oxygenation indicators were measured again. A hospital-made satisfaction questionnaire was used to evaluate the parents' satisfaction with nursing care.
RESULTS
Two children died of respiratory failure (one in the preterm group and one in the full-term group), and the rest were in a stable condition after surgery. There was no significant difference between the rates of parent satisfaction in the two groups (preterm infant group: 96.67% verse full-term group: 93.33%, P>0.05). In both groups, the partial pressure of oxygen in arterial blood (PaO2), partial pressure of oxygen in arterial blood/fraction of inspiration O2 (PaO2/FiO2), and partial pressure of oxygen in arterial blood/partial pressure of oxygen in the alveolar gas (PaO2/PAO2) in prone position were significantly higher than those in supine position (P<0.05); the alveolar-arterial oxygen difference (A-aDO2) was significantly lower than that in the supine position (0.05).
CONCLUSIONS
The prone position can improve the oxygenation index of children after surgery, and improve their respiratory system function. This method is suitable for newborn postoperative NICU care.
Topics: Humans; Infant, Newborn; Infant, Premature; Oxygen; Patient Positioning; Prone Position; Respiration, Artificial; Supine Position
PubMed: 32648464
DOI: 10.21037/apm-20-1003 -
Journal of Ultrasound Dec 2022Critical care echocardiography is a fundamental tool in the hemodynamic evaluation of critically ill patients and prone position ventilation might limit its application....
PURPOSE
Critical care echocardiography is a fundamental tool in the hemodynamic evaluation of critically ill patients and prone position ventilation might limit its application. We aim to evaluate the feasibility of transthoracic echocardiography to assess different measurements performed in prone vs supine position in patients during COVID-19 pandemic to answer our research question: What is the feasibility of classic echocardiographic measurements in COVID-19 patients in prone position ventilation?
METHODS
Patients with covid-19 admitted to ICUs in four academic hospitals with respiratory failure and on mechanical ventilation were evaluated with critical care echocardiography. The first ultrasound assessment was compared between prone and supine patients recording feasibility of several echocardiographic measurements, using Fisher's exact test complementing with Crombach's Alpha.
RESULTS
139 patients were included. Sixty-eight (49%) were evaluated in prone position and seventy one (51%) in supine position. Most variables were highly feasible, left ventricular volumes and ejection fraction were more possible to obtain in prone position, while cardiac output was in supine position. Tricuspid regurgitation was the least feasible overall measurement.
CONCLUSION
Prone position ultrasound achieved a high feasibility of measurements compared with supine ultrasound in critically ill patients with COVID-19 respiratory failure and on mechanical ventilation.
REGISTRATION
Post hoc analysis of Echo-COVID study (NTC04628195, registered November 13, 2020, retrospectively registered).
Topics: Humans; Prone Position; COVID-19; Feasibility Studies; Critical Illness; Pandemics; Critical Care; Respiratory Insufficiency; Echocardiography
PubMed: 35229275
DOI: 10.1007/s40477-022-00652-9 -
European Journal of Cardiovascular... Nov 2021Prone positioning is increasingly used for treating coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS). In these high-risk patients...
AIMS
Prone positioning is increasingly used for treating coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS). In these high-risk patients for cardiovascular events who may spend more than 16 h a day in the prone position, an adequate monitoring of electrocardiogram (ECG) is mandatory. However, effects of prone positioning on the ECG are unknown as is the validity of the ECG recorded with electrodes placed dorsally. We aimed to compare ECG data obtained in the prone position from five electrodes positioned conventionally and dorsally, and to assess the effects of the change of position (from supine to prone) on the ECGs in patients with COVID-19 ARDS.
METHODS AND RESULTS
In patients with COVID-19 ARDS for whom the prone position was indicated, seven-lead ECG (frontal plane leads and V6) performed in the supine and the prone position with electrodes positioned conventionally and dorsally were compared. A total of 22 patients [20 (91%) males] were included. Among them, 10 (45%) patients had structural or ischaemic heart disease. After prone positioning, PR duration significantly increased and QRS duration significantly decreased whereas QT interval did not significantly change. In the prone position, there were excellent correlations between QRS axis, PR, RR, QRS, and QT intervals durations measured with electrodes placed on the torso and dorsally (with no change in the position of V6).
CONCLUSION
Prone positioning induced significant change in the ECG. In the prone position, ECG can be reliably monitored with four electrodes translated from conventional position to the back and with a precordial electrode left in V6 position.
Topics: COVID-19; Electrocardiography; Humans; Male; Prone Position; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 34694381
DOI: 10.1093/eurjcn/zvab094 -
Journal of Wound, Ostomy, and... 2017The purpose of this study was to describe selected sacral tissue characteristics in a convenience sample of healthy volunteer subjects.
OBJECTIVES
The purpose of this study was to describe selected sacral tissue characteristics in a convenience sample of healthy volunteer subjects.
DESIGN
Descriptive.
SAMPLE AND SETTING
Fifty healthy volunteers in a clinical learning center in a school of nursing.
METHODS
Sacral scans were obtained using a 20-MHz ultrasound scanning system in 3 positions: prone and 60° and 90° side-lying from the back. The images were analyzed by software in the ultrasound program using quantitative parameters of dermal thickness and density (dermal median intensity and derived number of low-echogenic pixels to total pixels [LEP:TP] ratio).
RESULTS
In general, average values were as follows: dermal thickness between 2.32 and 2.65 mm; median pixel intensity between 102 and 112; and the LEP:TP ratio between 0.39 and 0.56. There were significant differences in sacral tissue characteristics between measures of thickness and dermal density (median intensity and LEP:TP ratio) by subject side-lying position (60° and 90°) versus prone position, with all P values less than .0001.
CONCLUSIONS
Overall, the ranges were consistent across measures of thickness and dermal density except for systematic differences between side-lying and prone positions. When comparing thickness, median intensity, or LEP:TP ratio, it is important to report subject position. To best recognize tissue inflammation indicative of pressure injuries before surface changes are seen, it is useful to understand healthy high-frequency ultrasound sacral tissue characteristics. It is anticipated that quantitative assessment of dermal thickness, density, and LEP:TP ratio could help identify individuals with incipient pressure injury.
Topics: Adult; Female; Humans; Male; Middle Aged; Posture; Prone Position; Radio Waves; Sacrococcygeal Region; Ultrasonography
PubMed: 28723853
DOI: 10.1097/WON.0000000000000354 -
Journal of Applied Physiology... Aug 2017Some astronauts are returning from long-duration spaceflight with structural ocular and visual changes. We investigated both the transient and sustained effects of...
Some astronauts are returning from long-duration spaceflight with structural ocular and visual changes. We investigated both the transient and sustained effects of changes in the direction of the gravity vector acting on the eye using changes in body posture. Intraocular pressure (IOP; measured by Perkins tonometer), ocular geometry (axial length, corneal thickness, and aqueous depth-noncontact biometer), and the choroid (volume and subfoveal thickness optical coherence tomography) were measured in 10 subjects (5 males and 5 females). Measures were taken over the course of 60 min and analyzed with repeated-measures analysis of covariance to assess the effects of posture and time. In the supine position, choroidal volume increased significantly with time (average value at <5 min = 8.8 ± 2.3 mm, 60 min = 9.0 ± 2.4 mm, = 0.03). In the prone position, IOP and axial length increased with time (IOP at <5 min 15 ± 2.7 mmHg, 60 min = 19.8 ± 4.1 mmHg, < 0.0001; axial length at <5 min = 24.29 ± 0.77 mm, 60 min = 24.31 ± 0.76 mm, = 0.002). Each increased exponentially, with time constants of 5.3 and 14 min, respectively. Prone corneal thickness also increased with time (<5 min = 528 ± 35 μm, 60 min = 537 ± 35 μm, < 0.001). Aqueous depth was shortened in the prone position (baseline = 3.22 ± 0.31 mm, 60 min = 3.18 ± 0.32 mm, < 0.0001) but did not change with time. The data show that changes in the gravity vector have pronounced transient and sustained effects on the geometry and physiology of the eye. We show that gravity has pronounced transient and sustained effects on the eye by making detailed ocular measurements over 60 min in the supine and prone postures. These data inform our understanding of how gravitational forces can affect ocular structures, which is essential for hypothesizing how ocular changes could occur with microgravity exposure.
Topics: Adult; Blood Pressure; Choroid; Female; Humans; Intraocular Pressure; Male; Posture; Prone Position; Tomography, Optical Coherence; Tonometry, Ocular; Weightlessness; Young Adult
PubMed: 28546470
DOI: 10.1152/japplphysiol.00687.2016 -
Unstable Inflation Causing Injury. Insight from Prone Position and Paired Computed Tomography Scans.American Journal of Respiratory and... Jul 2018It remains unclear how prone positioning improves survival in acute respiratory distress syndrome. Using serial computed tomography (CT), we previously reported that... (Comparative Study)
Comparative Study
RATIONALE
It remains unclear how prone positioning improves survival in acute respiratory distress syndrome. Using serial computed tomography (CT), we previously reported that "unstable" inflation (i.e., partial aeration with large tidal density swings, indicating increased local strain) is associated with injury progression.
OBJECTIVES
We prospectively tested whether prone position contains the early propagation of experimental lung injury by stabilizing inflation.
METHODS
Injury was induced by tracheal hydrochloric acid in rats; after randomization to supine or prone position, injurious ventilation was commenced using high tidal volume and low positive end-expiratory pressure. Paired end-inspiratory (EI) and end-expiratory (EE) CT scans were acquired at baseline and hourly up to 3 hours. Each sequential pair (EI, EE) of CT images was superimposed in parametric response maps to analyze inflation. Unstable inflation was then measured in each voxel in both dependent and nondependent lung. In addition, five pigs were imaged (EI and EE) prone versus supine, before and (1 hour) after hydrochloric acid aspiration.
MEASUREMENTS AND MAIN RESULTS
In rats, prone position limited lung injury propagation and increased survival (11/12 vs. 7/12 supine; P = 0.01). EI-EE densities, respiratory mechanics, and blood gases deteriorated more in supine versus prone rats. At baseline, more voxels with unstable inflation occurred in dependent versus nondependent regions when supine (41 ± 6% vs. 18 ± 7%; P < 0.01) but not when prone. In supine pigs, unstable inflation predominated in dorsal regions and was attenuated by prone positioning.
CONCLUSIONS
Prone position limits the radiologic progression of early lung injury. Minimizing unstable inflation in this setting may alleviate the burden of acute respiratory distress syndrome.
Topics: Animals; Humans; Models, Animal; Patient Positioning; Positive-Pressure Respiration; Prone Position; Rats; Respiration, Artificial; Respiratory Distress Syndrome; Supine Position; Swine; Tomography, X-Ray Computed; Ventilator-Induced Lung Injury
PubMed: 29420904
DOI: 10.1164/rccm.201708-1728OC -
PloS One 2019The 2017 Australian and Canadian 24-hour movement guidelines recommend infants receive 30 minutes of tummy time daily. Currently, there are no validated objective... (Clinical Trial)
Clinical Trial
The 2017 Australian and Canadian 24-hour movement guidelines recommend infants receive 30 minutes of tummy time daily. Currently, there are no validated objective measurement tools or devices to assess tummy time. The purpose of this study was to: 1) test the practicality of using devices on infants as an objective measure of tummy time, and 2) test the accuracy of developed algorithms and cut-points for predicting prone posture. Thirty-two healthy infants aged 4 to 25 weeks completed a protocol of 12 positions. Infants were placed in each position for 3 minutes while wearing a MonBaby (chest), GENEActiv (right hip) and two ActiGraphs (right hip and ankle). Direct observation was the criterion measure. The accuracy of the algorithms or cut-points to predict prone on floor, non-prone and prone supported positions were analyzed. Parents also completed a practicality questionnaire. Algorithms and cut-points to classify posture using devices from MonBaby, GENEActiv and ActiGraph (hip and ankle) were 79%, 95%, 90% and 88% accurate at defining tummy time and 100%, 98%, 100% and 96% accurate at defining non-prone positions, respectively. GENEActiv had the smallest mean difference and limits of agreement (-8.4s, limits of agreement [LoA]: -78.2 to 61.3s) for the prone on floor positions and ActiGraph Hip had the smallest mean difference and LoA for the non-prone positions (-0.2s, LoA: -1.2 to 0.9s). The majority of parents agreed all devices were practical and feasible to use with MonBaby being the preferred device. The evaluated algorithms and cut-points for GENEActiv and ActiGraph (hip) are of acceptable accuracy to objectively measure tummy time (time spent prone on floor). Accurate measurement of infant positioning practices will be important in the observation of 24-hour movement guidelines in the early years.
Topics: Algorithms; Child Development; Female; Humans; Infant; Infant, Newborn; Male; Prone Position
PubMed: 30811395
DOI: 10.1371/journal.pone.0210977 -
BMC Pulmonary Medicine Dec 2023Prone position is an option for rescue therapy for acute respiratory distress syndrome. However, there are limited relevant data among trauma and surgical patients, who... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prone position is an option for rescue therapy for acute respiratory distress syndrome. However, there are limited relevant data among trauma and surgical patients, who may be at increased risk for complications following position changes. This study aimed to identify the benefits and risks of proning in this patient subgroup.
METHODS
Follow the PRISMA 2020, MEDLINE and EMBASE database searches were conducted. Additional search of relevant primary literature and review articles was also performed. A random effects model was used to estimate the PF ratio, mortality rate, mechanical ventilator days, and intensive care unit length of stay using Review Manager 5.4.1 software.
RESULTS
Of 1,128 studies, 15 articles were included in this meta-analysis. The prone position significantly improved the PF ratio compared with the supine position (mean difference, 79.26; 95% CI, 53.38 to 105.13). The prone position group had a statistically significant mortality benefit (risk ratio [RR], 0.48; 95% CI, 0.35 to 0.67). Although there was no significant difference in the intensive care unit length of stay, the prone position significantly decreased mechanical ventilator days (-2.59; 95% CI, -4.21 to -0.97). On systematic review, minor complications were frequent, especially facial edema. There were no differences in local wound complications.
CONCLUSIONS
The prone position has comparable complications to the supine position. With its benefits of increased oxygenation and decreased mortality, the prone position can be considered for trauma and surgical patients. A prospective multicenter study is warranted.
Topics: Humans; Respiration, Artificial; Prone Position; Prospective Studies; Intensive Care Units; Respiratory Distress Syndrome; Multicenter Studies as Topic
PubMed: 38093216
DOI: 10.1186/s12890-023-02805-w -
Journal of Applied Physiology... Apr 2019The rebreathing of expire air, with high carbon dioxide and low oxygen concentrations, has long been implicated in unexplained Sudden Infant Death Syndrome (SIDS) when...
The rebreathing of expire air, with high carbon dioxide and low oxygen concentrations, has long been implicated in unexplained Sudden Infant Death Syndrome (SIDS) when infants are placed to sleep in a prone (facedown) position. This study elucidates the effect of the aerodynamic parameters Reynolds number, Strouhal number, and Froude number on the percentage of expired air that is reinspired (rebreathed). A nasal module was designed that served as a simplified geometric representation of infant nostrils and placed above a hard, flat surface. Quantitative and flow visualization experiments were performed to measure rebreathing, using water as the working medium, under conditions of dynamic similarity. Different anatomic (e.g., tidal volume, nostril diameter), physiological (e.g., breathing frequency), and environmental (e.g., temperature, distance from the surface) factors were considered. Increases in Strouhal number (simultaneously faster and shallower breathing) always produced higher rebreathed percentages, because rolled-up vortices in the vicinity of the nostrils had less time to move away by self-induction. Positively and negatively buoyant flows resulted in significant rebreathing. In the latter case, consistent with a warm environment and a high percentage of rebreathed CO, denser gas pooled in the vicinity of the nostrils. Reynolds numbers below 200 also dramatically increased rebreathing because the expired gas pooled much closer to the nostrils. These results clearly elucidated how the prone position dramatically increases rebreathing by a number of different mechanisms. Furthermore, the results offer plausible explanations of why a high-temperature environment and low birthweight are SIDS risk factors. NEW & NOTEWORTHY A fundamentally new aerodynamics-based approach to the study of rebreathing of expired air in infants is presented. Rebreathing is implicated in unexplained Sudden Infant Death Syndrome (SIDS) when infants sleep in a prone position. This is the first time that aerodynamic parameters are systematically varied and their effects on rebreathing quantified. The study provides us with a deeper understanding of the effects of breathing frequency, tidal volume (birthweight) and environmental conditions.
Topics: Carbon Dioxide; Humans; Infant, Newborn; Oxygen; Prone Position; Respiration; Risk Factors; Sleep; Sudden Infant Death; Temperature; Tidal Volume
PubMed: 30605404
DOI: 10.1152/japplphysiol.00784.2018 -
Critical Care Medicine Nov 2023
Topics: Humans; Prone Position; Respiratory Distress Syndrome; Patient Positioning; Respiration, Artificial
PubMed: 37902350
DOI: 10.1097/CCM.0000000000005978