Sitting Prone Position for the Posterior Surgical Approach to the Spine and Posterior Fossa

Neurosurgery ◽  
1982 ◽  
Vol 10 (2) ◽  
pp. 232-235 ◽  
Author(s):  
Albert W. Cook ◽  
Tariq S. Siddiqi ◽  
Florence Nidzgorski ◽  
Hadley A. Clarke
Keyword(s):  
Central Venous Pressure ◽  
Prone Position ◽  
Posterior Fossa ◽  
Surgical Approach ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Posterior Fossa Surgery ◽  
Comparative Efficacy ◽  
Central Venous ◽  
Significant Difference

Abstract The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure.

Osmoregulatory control of renal sodium excretion after sodium loading in humans

1998 ◽  
Vol 275 (6) ◽  
pp. R1833-R1842 ◽  
Author(s):  
Lars Juel Andersen ◽  
Peter Norsk ◽  
Lars Bo Johansen ◽  
Poul Christensen ◽  
Thomas Engstrøm ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Sodium Excretion ◽  
Salt Intake ◽  
Sodium Intake ◽  
Venous Pressure ◽  
Sodium Balance ◽  
Plasma Sodium ◽  
Central Venous ◽  
Salt Loading ◽  
Significant Difference

The hypothesis that renal sodium handling is controlled by changes in plasma sodium concentration was tested in seated volunteers. A standard salt load (3.08 mmol/kg body wt over 120 min) was administered as 0.9% saline (Isot) or as 5% saline (Hypr) after 4 days of constant sodium intake of 75 (LoNa+) or 300 mmol/day (HiNa+). Hypr increased plasma sodium by ∼4 mmol/l but increased plasma volume and central venous pressure significantly less than Isot irrespective of diet. After LoNa+, Hypr induced a smaller increase in sodium excretion than Isot (48 ± 8 vs. 110 ± 17 μmol/min). However, after HiNa+the corresponding natriureses were identical (135 ± 33 vs. 139 ± 39 μmol/min), despite significant difference between the increases in central venous pressure. Decreases in plasma ANG II concentrations of 23–52% were inversely related to sodium excretion. Mean arterial pressure, plasma oxytocin and atrial natriuretic peptide concentrations, and urinary excretion rates of endothelin-1 and urodilatin remained unchanged. The results indicate that an increase in plasma sodium may contribute to the natriuresis of salt loading when salt intake is high, supporting the hypothesis that osmostimulated natriuresis is dependent on sodium balance in normal seated humans.

scholarly journals Uppermost Blood Levels of the Right and Left Atria in the Supine Position

2007 ◽  
Vol 107 (2) ◽  
pp. 260-263 ◽  
Author(s):  
Jeong-Hwa Seo ◽  
Chul-Woo Jung ◽  
Jae-Hyon Bahk
Keyword(s):  
Pulmonary Artery ◽  
Central Venous Pressure ◽  
Supine Position ◽  
Pressure Transducer ◽  
Venous Pressure ◽  
Blood Levels ◽  
Pulmonary Artery Wedge Pressure ◽  
Central Venous ◽  
Significant Difference ◽  
Wedge Pressure

Background To eliminate the influence of hydrostatic pressure, proper transducer positions for central venous pressure and pulmonary artery wedge pressure are at the uppermost blood levels of right atrium (RA) and left atrium (LA). This study was performed to investigate accurate reference levels of central venous pressure and pulmonary artery wedge pressure in the supine position. Methods Chest computed tomography images of 96 patients without history of cardiothoracic surgery, heart disease, or cardiothoracic anatomical abnormality were retrospectively reviewed. The anteroposterior (AP) diameter of the thorax and the vertical distances from the skin on the back to the most anterior portion of RA (RA height) and LA (LA height) were measured. Their ratios were abbreviated, respectively, as RA height/AP diameter and LA height/AP diameter. Data are expressed as mean +/- SD (range). Results There was a significant difference [4.6 +/- 1.0 (1.6-6.4) cm; P < 0.001] between RA and LA heights. AP diameter was positively correlated with RA and LA heights (R = 0.839 and 0.700, respectively; P < 0.001). There was also a significant difference between RA height/AP diameter [0.83 +/- 0.03 (0.71-0.91)] and LA height/AP diameter [0.62 +/- 0.04 (0.52-0.72)] (P < 0.001). Conclusion In the supine position, a central venous pressure transducer should be positioned approximately 4.6 cm higher than a pulmonary artery wedge pressure transducer. The external reference level for central venous pressure seems to be at approximately four fifths of the AP diameter of the thorax from the back, and that for pulmonary artery wedge pressure seems to be at approximately three fifths of the AP diameter.

scholarly journals Risk factors for the appearance of central venous catheters colonization

2007 ◽  
Vol 64 (11) ◽  
pp. 760-764 ◽  
Author(s):  
Vesna Mioljevic ◽  
Vesna Suljagic ◽  
Biljana Jovanovic ◽  
Jelena Gligorijevic ◽  
Snezana Jovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Insertion Site ◽  
Medical Documentation ◽  
Causative Organism ◽  
Central Venous ◽  
Isolation And Identification ◽  
Microbiological Methods ◽  
Significant Difference

Introduction/Aim. Intravascular device placement (IVD) is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI) and increased mortality and morbidity. Nosocomial blood infections (NBIs) account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs). Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC) was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long) were analyzed. Based on the insight into medical documentation, patients? examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52%) were sterile while 51 (48%) were colonized. The results of our study evidenced that total parenteral nutrition (TPN) (p < 0.05), number of catheterization days (p < 0.05), and central venous pressure measurement (p < 0.05) were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter colonization was found with respect to sex, age, anatomical insertion site and CVC placement site. Conclusion. According to the results of our study, TPN, the number of catheterization days and measurement of central venous pressure play major roles in colonization of CVC. Understanding risk factors associated with CVC colonization and onset of CANBIs is a prerequisite for quality preventive work of health professionals.

scholarly journals Fluctuations of driving pressure during mechanical ventilation indicates elevated central venous pressure and poor outcomes

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402097036
Author(s):  
Jia-Yu Mao ◽  
Dong-Kai Li ◽  
Xin Ding ◽  
Hong-Min Zhang ◽  
Yun Long ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Central Venous Pressure ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Driving Pressure ◽  
Hospital Length Of Stay ◽  
Central Venous ◽  
College Hospital ◽  
Wide Range ◽  
The Relationship

Inappropriate mechanical ventilation may induce hemodynamic alterations through cardiopulmonary interactions. The aim of this study was to explore the relationship between airway pressure and central venous pressure during the first 72 h of mechanical ventilation and its relevance to patient outcomes. We conducted a retrospective study of the Department of Critical Care Medicine of Peking Union Medical College Hospital and a secondary analysis of the MIMIC-III clinical database. The relationship between the ranges of driving pressure and central venous pressure during the first 72 h and their associations with prognosis were investigated. Data from 2790 patients were analyzed. Wide range of driving airway pressure (odds ratio, 1.0681; 95% CI, 1.0415–1.0953; p < 0.0001) were independently associated with mortality, ventilator-free time, intensive care unit and hospital length of stay. Furthermore, wide range of driving pressure and elevated central venous pressure exhibited a close correlation. The area under receiver operating characteristic demonstrated that range of driving pressure and central venous pressure were measured at 0.689 (95% CI, 0.670–0.707) and 0.681 (95% CI, 0.662–0.699), respectively. Patients with high ranges of driving pressure and elevated central venous pressure had worse outcomes. Post hoc tests showed significant differences in 28-day survival rates (log-rank (Mantel–Cox), 184.7; p < 0.001). In conclusion, during the first 72 h of mechanical ventilation, patients with hypoxia with fluctuating driving airway pressure have elevated central venous pressure and worse outcomes.

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