Rehabilitation in the intensive care unit
Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein in Pulmonary Rehabilitation, 2020
For many years, based on a ‘conservative’ paradigm, mobilization and physiotherapy of critically ill patients was considered unsafe and was postponed until after discharge from the ICU. Patients were considered too sick for any form of physical activity (PA) and there was also concern that activity might dislodge intracavitary tubes and intravascular lines. Support for the viewpoint came from observations such as: Bed rest requiring a lower muscle oxygen consumption results in more availability to repair vital organs.Lower ventilatory requirements diminish the risk of ventilator-induced lung injury, allowing lower tidal volumes and a lower inspired oxygen fraction.The supine position could facilitate blood flow to the brain, reduce the risk of falls and reduce pain to injured parts of the body.Lower blood pressure and oxygen consumption could mean less cardiac workload and a lower risk of arrhytmias and ischaemia.
Management of osteoporotic extra-articular proximal tibial fractures
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
The procedure was performed with the patient in supine position. Under fluoroscopic views, reduction was obtained with longitudinal traction and a pointed reduction clamp. Then a lateral approach to the proximal tibia was performed, the fascia of the anterior compartment incised, and the iliotibial band retracted posteriorly. The fracture was exposed, and after minimal periosteal stripping, the hematoma was evacuated. The fracture was reduced under direct visualization and reduction temporarily maintained with a reduction clamp; at this point, a lag screw was placed across the fracture plane. A 12-hole locking compression plate was inserted over the lateral aspect of the proximal tibia, and its position and the quality of the reduction were assessed under fluoroscopic orthogonal views. Four cortical screws were placed in the distal fragment, six locking screws were placed in the proximal fragment, and finally a kickstand screw was placed for additional support. A small medial incision was then made, and an 8-hole 3.5 mm reconstruction plate was slid using the MIPO technique. Plate position and alignment were checked using the image intensifier, three unicortical locking screws were placed proximally, and two bicortical nonlocked screws were placed in the distal fragment. The final quality of reduction and implant position were assessed using fluoroscopic AP and lateral views, and surgical wounds were irrigated and closed (Figure 26.8c,d). The patient was placed in a bulky splint and was allowed to be toe-touch weight-bearing for the first 6 weeks.
Psychiatric Emergencies in Women
R. Thara, Lakshmi Vijayakumar in Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Restraint must be used only as a last option in aggressive and agitated women. The safety and rights of the woman and fetus must be borne in mind: The following guidelines must be considered (NSW Government 2012): Holding a pregnant patient in the seated position is safer than in any other position.If there is need to lie them down, pregnant patients should be positioned in the left lateral position (on her left side) to reduce the likelihood of compression of the aorta and vena cava.Do not restrain the pregnant woman in the supine position for extended periods of time.Avoid restraining in the prone position as this could lead to airway obstruction and respiratory distress.Identify and manage any medical risk factors.Observe the patient every 15 minutes for the first hour and every 30–45 minutes thereafter till she calms down.
Clinical efficacy and safety of a highly conformal, supine, hybrid forward and inverse planned intensity modulated radiation therapy technique for craniospinal irradiation
Published in Acta Oncologica, 2018
Safia K. Ahmed, Jon J. Kruse, Thomas B. Bradley, Chris J. Beltran, Nadia N. Issa Laack
Contemporary CSI techniques eliminate several of the limitations associated with conventional treatment. Traditional techniques require patients be in the prone position in order to utilize skin surface markers to match adjacent fields and to manually shift field junctions during treatment. This interfractional ‘feathering’ of field junctions creates sensitive dose gradients that produce inadvertent hot or cold spots in the spinal canal with positional variations [15]. Our technique tackles the traditional field junction pitfalls by overlapping adjacent fields and using MLC and FIF apertures to blend dose across the junctions. This approach results in at least a 6 cm dose gradient that is less susceptible to longitudinal positional variations. Our technique also improves upon treatment efficiency by only utilizing longitudinal couch shifts for imaging and treatment, compared to couch shifts and rotations required with traditional techniques. Finally, the supine position is more comfortable for patients and allows for easier airway access for pediatric patients requiring anesthesia.
Chronic Thromboembolic Disease: Epidemiology, Assessment with Invasive Cardiopulmonary Exercise Testing, and Options for Management
Published in Structural Heart, 2021
W. Cameron McGuire, Mona Alotaibi, Timothy A. Morris, Nick H. Kim, Timothy M. Fernandes
Right heart catheterization is performed on a table equipped with a specialized cycle ergometer (produced by Medical Positioning, Inc.) to allow supine exercise. The advantage of the supine position is that it allows for a stable zeroing of the pressure transducer at a position in the mid-thoracic line half way between the anterior sternum and the bed. As opposed to an upright cycle ergometer, which can affect the quality of the tracings, the tracings in this supine position are subject to less noise due to patient movement. The major disadvantage of the supine position for exercise is that the VO2 maximum is dependent on the muscle groups being exercised. In the supine position, the core muscles are recruited to keep the legs upright. As a result, the VO2 maximum achieved in a supine position is lower than what is achieved in the upright position.15 While these differences in the VO2 maximum would be clinically relevant for certain indications for a noninvasive cardiopulmonary exercise test (i.e. prognostication for CHF and PAH), the questions posed for the iCPET in patients with suspected CTED often can be answered with the submaximal VO2 obtained in the supine position.
Current and future strategies for diagnostic and management of obstructive sleep apnea
Published in Expert Review of Molecular Diagnostics, 2021
Sartaj Khurana, Narshone Soda, Muhammad J. A. Shiddiky, Ranu Nayak, Sudeep Bose
Obesity has been regarded as one of the most common and potential risk factors for OSA [128]. Food habits such as increased calorie intake especially high in carbohydrates have been seen to be associated with OSA severity [129]. Several studies have demonstrated that weight loss achieved through very low calorie diet intake has been successful in alleviating the symptoms of OSA by improving the BMI and AHI [130]. Very low calorie diet accompanied with active lifestyle not only results in weight loss and OSA tolerance but also improves other existing comorbidities such as hypertension, cardiovascular diseases, and diabetes by improving a range of cardiovascular variables [131]. Mediterranean diets have been observed to be beneficial for weight loss as they promote satiation and encourage adherence to calorie-restricted diets [132]. Moreover, surgically induced weight loss has also been associated with improvements in OSA severity, associated clinical conditions, and overall quality of life [133]. However, in morbidly obese OSA patients, only weight loss cannot completely cure OSA and additional therapies are required. In addition to diet mediated weight loss, changing of sleeping postures has been advised to alleviate the symptoms of OSA. Supine position increases the likelihood of the tongue falling back into the airway as a result of gravity, thereby blocking the airway. Therefore, positional therapy is advised in OSA patients to reduce the apneic events from occurring.
Related Knowledge Centers
- Autonomic Nervous System
- Carbon Dioxide
- Central Chemoreceptors
- Obstructive Sleep Apnea
- Peritoneum
- Respiratory Acidosis
- Thorax
- Hyperventilation
- Prone Position
- Pericardium