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2.
Intensive Care Med ; 48(12): 1793-1795, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2128543
3.
JBJS Case Connect ; 11(1)2021 03 19.
Article in English | MEDLINE | ID: covidwho-2115210

ABSTRACT

CASE: We describe a preliminary report of 3 cases of ulnar neuropathy after coronavirus disease 2019 (COVID-19) infection and treatment with intermittent prone positioning. CONCLUSION: Ulnar neuropathy may be associated with recent COVID-19 infection. The natural process of the disease and intermittent prone positioning are likely risk factors contributing to this finding. Conservative management seems to lead to improvement of symptoms.


Subject(s)
COVID-19/therapy , Intubation, Intratracheal/adverse effects , Patient Positioning/adverse effects , Prone Position , Ulnar Neuropathies/etiology , COVID-19/virology , Female , Humans , Male , Middle Aged , SARS-CoV-2
4.
Anaesthesiologie ; 71(11): 858-864, 2022 Nov.
Article in German | MEDLINE | ID: covidwho-2085322

ABSTRACT

Meralgia paraesthetica (MP) is the consequence of an entrapment or stretch injury of the lateral femoral cutaneous nerve at the crossing region with the inguinal ligament where the nerve exits the pelvis. It results in temporary or permanent sensory loss, paraesthesia and pain in the anterolateral region of the thigh. Idiopathic forms are known for example as seat belt syndrome or jeans syndrome. An MP can also occur as a complication of surgical or intensive care patient positioning. In focus are the lithotomy position, prone position and beach chair position.We analyzed 21 complaints about MP occurring for the first time postoperatively, which had been submitted to the expert committee for medical treatment errors at the North Rhine Medical Association over the past 10 years. Among these, six cases could be identified as positioning damage after a lithotomy position. In three cases MP occurred after supine positioning but the etiology could not be clarified with certainty. In 12 cases MP was recognized as a direct surgical complication.The pathophysiology, incidence and course as well as legal implications of position-related MP are discussed. Pressure damage to the nerve at its intersection with the inguinal ligament is assumed to be the main pathomechanism. Although all the cases presented here occurred after lithotomy positioning, the complication also appears to occur with other types of positioning according to the literature data, the most common being prone positioning. This also explains the increasingly published case reports of MP after prone positioning in COVID-19 patients for respiratory treatment. Safe avoidance of the positioning-related complication does not appear to be possible due to the anatomical variability of the course of the nerve and the unclear pathomechanisms.


Subject(s)
COVID-19 , Femoral Neuropathy , Nerve Compression Syndromes , Humans , Femoral Neuropathy/etiology , Nerve Compression Syndromes/etiology , Thigh/innervation , Patient Positioning/adverse effects
9.
Ann Am Thorac Soc ; 19(10): 1634-1635, 2022 10.
Article in English | MEDLINE | ID: covidwho-2054423
13.
Ann Intern Med ; 175(9): JC99, 2022 09.
Article in English | MEDLINE | ID: covidwho-2025313

ABSTRACT

SOURCE CITATION: Alhazzani W, Parhar KK, Weatherald J, et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure: a randomized clinical trial. JAMA. 2022;327:2104-13. 35569448.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , Hypoxia/therapy , Intubation, Intratracheal , Patient Positioning , Prone Position , Wakefulness
14.
Nursing ; 52(9): 43-48, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2008643

ABSTRACT

ABSTRACT: This article discusses the pathophysiology of COVID-19 acute respiratory distress syndrome (ARDS), the evidence supporting the use of awake prone positioning (APP) for adult patients with COVID-19 ARDS cared for in acute care medical units, and a quality improvement initiative to support a standardized APP process on a COVID-19 medical unit.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Adult , COVID-19/epidemiology , Humans , Nurse's Role , Patient Positioning , Prone Position , Respiratory Distress Syndrome/therapy , Wakefulness
15.
Eur J Med Res ; 27(1): 149, 2022 Aug 12.
Article in English | MEDLINE | ID: covidwho-1993388

ABSTRACT

BACKGROUND: To investigate whether prone position can reduce the risk of patients with mild or moderate COVID-19 who progress to severe or critical illness. METHODS: The prone position group was treated in prone position on the day of admission in addition to conventional treatment. Indicators such as saturation of pulse oximetry (SpO2), heart rate, blood pressure, respiratory rate, and prone position-related adverse events were recorded before prone ventilation, 5 min after prone position and 30 min after prone position. Meanwhile, the cases of severe and critical patients, the percentage of transformation and the final clinical outcome of this group were analyzed. Conversion rates and mortality were calculated for patients with mild or moderate COVID-19 retrieved from the database who received only conventional care without combined prone positioning as control group. RESULTS: (1) A total of 34 patients were included in prone position group. There were significant differences in SpO2 between the first 4 days after admission and the day of discharge (F = 3.17, P < 0.001). (2) The main complications were back and neck muscle soreness (55.9%), followed by abdominal distension (8.9%). (3) In control group, a total of 4873 cases of mild and moderate patients were included from 19 literatures, with an average deterioration rate of 22.7% and mortality rate of 1.7%. (4) In prone position group, there were no severe or critical transformation cases and also no death cases. The prone position group had a significantly lower deterioration rate when compared with the control group (χ2 = 9.962, P < 0.01). CONCLUSION: Prone position improves SpO2 in patients with mild or moderate COVID-19. It can also reduce the percentage of mild or moderate patients progressing to severe or critical patients. The application of prone position is a simple, feasible, safe and effective treatment method in such patients.


Subject(s)
COVID-19 , Humans , Patient Positioning/methods , Prone Position , Respiration, Artificial/methods , Retrospective Studies
16.
Ann Intern Med ; 175(7): JC81, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1988425

ABSTRACT

SOURCE CITATION: Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med. 2022;10:573-83. 35305308.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , Intubation, Intratracheal , Patient Positioning , Prone Position , Respiratory Insufficiency/therapy , Supine Position , Wakefulness
17.
Lung ; 200(4): 441-445, 2022 08.
Article in English | MEDLINE | ID: covidwho-1982146

ABSTRACT

PURPOSE: Prone position is known to improve acute lung injury, and chest radiographs are often necessary to monitor disease and confirm support device placement. However, there is a paucity of literature regarding radiographs obtained in this position. We evaluated prone radiographs for distinguishing features and ability to identify support devices. METHODS: Pairs of prone and supine radiographs obtained during the COVID-19 pandemic were assessed retrospectively. IRB approval and waiver of informed consent were obtained. Radiographs were assessed for imaging adequacy, distinguishing features, and support device identification (endotracheal tube, enteric tube, or central line). Radiographs were reviewed by ≥ 2 cardiothoracic radiologists. RESULTS: Radiographs from 81 patients (63yo ± 13, 30% women) were reviewed. Prone and supine radiographs were comparable for imaging the lung bases (81% vs. 90%, p = 0.35) and apices (93% vs. 94%, p = 1); prone radiographs more frequently had significant rotation (36% vs. 19%, p = 0.021). To identify prone technique, scapula tip located beyond the rib border was 89% sensitive (95%CI 80-95%) and 85% specific (76-92%), and a fundal stomach bubble was 44% sensitive (33-56%) and 90% specific (81-96%). For women, displaced breast shadow was 46% sensitive (26-67%) and 92% specific (73-99%). Prone and supine radiographs each identified > 99% of support devices. Prone exams trended toward increased rate of malpositioned device (12% vs. 6%, p = 0.07). CONCLUSION: Scapula position reliably distinguishes prone from supine position; fundal stomach bubble or displaced breast shadow is specific for prone position. Prone radiographs reliably identify line and tube position, which is particularly important as prone patients appear at increased risk for malpositioned devices.


Subject(s)
COVID-19 , Pandemics , COVID-19/diagnostic imaging , Female , Humans , Male , Patient Positioning/methods , Prone Position , Retrospective Studies , Supine Position
20.
JAMA Intern Med ; 182(9): 1013-1014, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-1971171
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