Prone Position
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2021 ◽  
Vol 21 (1) ◽  
Ryota Watanabe ◽  
Koichi Suehiro ◽  
Akira Mukai ◽  
Katsuaki Tanaka ◽  
Tokuhiro Yamada ◽  

Abstract Background The present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position. Methods Thirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM. Results Areas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients). Conclusion In prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance. Trial registration UMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.

2021 ◽  
Vol 46 ◽  
pp. S650
C.L. Barbosa ◽  
C.H. Ferreira ◽  
N.L.F.D.A. Gimeniz ◽  
T.M.S. Souza ◽  
C.M.V. de Oliveira ◽  

Ioli Pereira Costa ◽  
Juliana Soares Magno de Senna ◽  
Stephanie Rodrigues ◽  
Camila Vitelli Molinari ◽  
Vivian Bertoni Xavier ◽  

Introdução: A pandemia da COVID-19 exigiu recursos e esforços de diversos profissionais de saúde para melhorar a assistência aos pacientes acometidos. A fisioterapia ganhou destaque na redução da progressão da doença em sintomas respiratórios e na manutenção da capacidade funcional e física. Objetivo: Apresentar um dos casos de assistência fisioterapêutica de um paciente com COVID-19, da internação na unidade de terapia intensiva (UTI) à reabilitação ambulatorial e os recursos utilizados, de forma a demonstrar o benefício da fisioterapia ao longo de todo o percurso do paciente até a alta. Relato do caso: Homem de 53 anos foi internado devido a piora clínica, queixa de dispneia em repouso associada a febre, tosse seca, agenesia e hipoxemia. Admitido à UTI com acometimento de 50% do parênquima pulmonar em tomografia computadorizada, recebeu oxigênio a 10 L/min, para atingir saturação periférica de oxigênio (SpO2) a 99% e relação de pressão parcial de oxigênio arterial (PaO2/FiO2) a 95. Durante nove dias de internação, recebeu atendimento de fisioterapia quatro vezes ao dia, com recursos de ventilação não invasiva, prona ativa, sedestação, deambulação precoce e recursos de aumento de demanda física ajustada progressivamente de acordo com a avaliação e objetivo terapêutico. Na alta hospitalar, com remissão dos sintomas importantes, sem oxigênio e SpO2 a 96%, PaO2/FiO2 a 302, foi encaminhado para reabilitação cardiopulmonar e, após 38 sessões, recuperou a capacidade funcional e recebeu alta do serviço com teste de caminhada de seis minutos com valores adequados para a idade e sexo. Conclusão: Neste caso de COVID19, os objetivos terapêuticos da fisioterapia foram alcançados desde a internação até a reabilitação, com utilização de recursos conhecidos pela especialidade e priorizando os cuidados contínuos e a personalização da terapia. Palavras chave: COVID-19, Modalidades de fisioterapia, Ventilação não invasiva, decúbito ventral, Deambulação precoce ABSTRACT Introduction: The COVID-19 pandemic required resources and efforts from health professionals to improve care for affected patients. Physical therapy has gained prominence in reducing the progression of the disease in respiratory symptoms and in maintaining functional and physical capacity. Objective: To report one of the cases of physiotherapy care of a patient with COVID-19, from admission to the intensive care unit (ICU) to outpatient rehabilitation and the resources used, in order to demonstrate the benefit of physiotherapy throughout the course of the patient until discharge. Case report: A 53 -year-old man was admitted due to clinical worsening, complaint of dyspnea at rest associated with fever, dry cough, agenesis and hypoxemia. Admitted to ICU with 50% involvement of the lung parenchyma on computed tomography, he received oxygen at 10 L/min to achieve peripheral oxygen saturation (SpO2) at 99% and arterial oxygen partial pressure ratio (PaO2/FiO2) at 95. During nine days of hospitalization, he received physiotherapy care four times a day, with non-invasive ventilation, prone position, sitting, early ambulation and resources for increasing physical demand, progressively adjusted according to the assessment and therapeutic objective. At hospital discharge, with remission of important symptoms, without oxygen and SpO2 96%, PaO2/FiO2 to 302, he was referred for cardiopulmonary rehabilitation and, after 38 sessions, he recovered functional capacity and was discharged from the service with a six-walk test minutes with appropriate values for age and sex. Conclusion: In this case of COVID19, the therapeutic objectives of physiotherapy were achieved from hospitalization to rehabilitation, using resources known by the specialty and prioritizing continuous care and personalized therapy.Keywords: COVID-19, Physical therapy modalities, Noninvasive ventilation, Prone position, Early ambulation

2021 ◽  
Vol 10 (23) ◽  
pp. 5605
Ewa Gajewska ◽  
Jerzy Moczko ◽  
Mariusz Naczk ◽  
Alicja Naczk ◽  
Barbara Steinborn ◽  

Early assessment of motor performance should allow not only the detection of disturbances but also create a starting point for the therapy. Unfortunately, a commonly recognised method that should combine these two aspects is still missing. The aim of the study is to analyse the relationship between the qualitative assessment of motor development at the age of 3 months and the acquisition of the crawl position in the 7th month of life. A total of 135 children were enrolled (66 females). The analysis was based on physiotherapeutic and neurological assessment and was performed in the 3rd, 7th and 9th months of life in children, who were classified according to whether they attained the crawl position or not in the 7th month. Children who did not attain the crawl position in the 7th month did not show distal elements of motor performance at the age of 3 months and thus achieved a lower sum in the qualitative assessment. Proper position of the pelvis at the age of 3 months proved to be very important for the achievement of the proper crawl position at the 7th month. Failure to attain the crawl position in the 7th month delays further motor development. The proximal-distal development must be achieved before a child is able to assume the crawl position. Supine position in the 3rd month seemed more strongly related to achieving the crawl position than assessment in the prone position.

2021 ◽  
pp. respcare.08982
Vanessa M Oliveira ◽  
Ruy A Barcellos ◽  
Daniele M Piekala ◽  
Miriane MS Moretti ◽  
Dulce I Welter ◽  

Anand Misra ◽  
Akshay Pal ◽  
Rajni Pawar

Background: Physiotherapeutic intervention body positioning have been observed to increase oxygen saturation.  In COVID-19 patients, we intended to investigate how the prone position worked in conjunction with conventional respiratory physiotherapy. The objective was to determine the effect of prone position along with conventional respiratory physiotherapy on SpO2 of COVID-19 patients in Aurobindo hospital, Indore district. Methods: The Ministry of Health, Government of India, authorized the rules for collecting data from infected patients. In this study, 400 patients between the ages of 20 and 80 years old were recruited from Sri Aurobindo Hospital in the Indore district, all of them had a confirmed diagnosis of COVID-19 and required oxygen treatment. SpO2 data was collected as a baseline. Patients were helped into the prone position after baseline data collection and conventional respiratory physiotherapy. Clinical data was obtained again after using the prone posture in conjunction with conventional respiratory physiotherapy. To demonstrate the various prone variations, a patient information sheet was supplied. At 0 and 60 minutes after the exercise, oxygen saturation was measured. Results: Between April 2020 to June 2020, we assessed SpO2 of 400 Patients pre and post prone position along with conventional respiratory physiotherapy. Prone positioning was feasible. Oxygenation was significantly improved from supine to prone position. The data were processed for mean and standard deviation. It was analyzed that there was difference in pre to post value of mean, from 95.685 to 98.123 with standard deviation from 1.645to 1.445. The result shows significant improvement in SpO2 after applying prone positioning in patients infected with COVID-19. The findings suggest that prone positioning is both possible and beneficial in increasing blood oxygenation in awake COVID-19 patients. Further study is needed to find the technique's potential value in terms of enhancing overall respiratory and global outcomes. Conclusion: The difference between the saturation of the two position was significant.

2022 ◽  
Vol 35 ◽  
pp. 6-8
Evangelos Liatsikos ◽  
Arman Tsaturyan ◽  
Panagiotis Kallidonis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Maram Desokey ◽  
Fatma Farouk ◽  
Azza Abdelnaby ◽  
Ibrahim Awad

2021 ◽  
Vol 12 (2) ◽  
pp. 001-005
Omar Fadili ◽  
Abdellah Chrak ◽  
Souhail Echchoual ◽  
Mohamed Laffani ◽  
Mustapha Fadili

Neglected Achilles tendon ruptures are becoming more common. The etiologies are numerous, often complicating acute ruptures of the undiagnosed calcaneal tendon, whether by ignorance of the pathognomonic signs (loss of the physiological equine in prone position and Thomson’s maneuver) or by erroneous diagnosis of partial rupture often induced by an ultrasound. Also, it can be due to an iterative ruptures or ruptures on a pathological tendon. The treatment is always performed by a surgery. However, techniques are numerous and depend on the indications. We describe in this work the surgical technique of repairing neglected Achilles tendon ruptures according to Bosworth, performed in the Department of Traumatology-Orthopedics and Reconstructive Surgery of the Ibn Rochd University Hospital Center in Casablanca, Morocco.

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