The value of prone imaging in CT pneumocolon

AIM: To evaluate the value of prone imaging in computed tomography pneumocolon. MATERIALS AND METHODS: In the U.K., patients commonly undergo computed tomography (CT) pneumocolon in the supine position alone. A prospective analysis of both supine and prone CT images was performed. The degree of distension and the presence/absence of fluid/faecal residue were documented. RESULTS: Twenty-five patients were examined in total. In all cases, all five segments of the colon were well visualized on combined assessment of supine/prone images. Diagnostic distension was obtained in all five segments of the bowel in 69% of cases in the prone position, but in only 24% of patients in the supine position. The rectum and sigmoid colon were well distended in 100 and 88%, respectively, on prone CT, but in only 58 and 35% of cases, respectively, on supine CT. Problems encountered by fluid/faecal residue were eliminated on prone CT. CONCLUSION: Adjunctive prone pelvic CT should be performed in all patients undergoing CT pneumocolon unless the supine images can be fully reviewed and shown to be satisfactory before the patient leaves the CT department. If a single positional sequence is to be performed, then prone CT is the position of choice.     

Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome

BACKGROUND: Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be associated with improved outcome. To fulfil this approach, sedation, neuromuscular blocking agents and full mechanical ventilatory support are often used in critical failure of gas exchange. CASE REPORT: We present a patient who developed multiple organ failure, including severe ARDS, after severe skin injuries and septic shock. Ventilatory strategy consisted of lung protective approach, permissive hypercapnia and prone positioning. Airway pressure release ventilation (APRV) with the patient's superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after application of combined use of APRV and prone positioning. CONCLUSION: APRV and maintenance of patients' spontaneous ventilation is feasible during prone positioning, and this approach may have beneficial synergistic effects on gas exhange in patients with severe acute lung injury.     

Seasonal differences in risk factors for sudden infant death syndrome. The New Zealand Cot Death Study Group

The aim of this study was to explore whether the risk of sudden infant death syndrome (SIDS) associated with prone sleeping position and other risk factors varies with season. The study was a large nation-wide case-control study, which compared 485 cases with 1800 controls. Parents of 393 (81.0%) cases and 1591 (88.4%) controls were interviewed. Obstetric records were also examined. Infants dying in winter were older and had lower birthweights than those dying in summer. The increased risk of SIDS associated with prone sleeping position was greater in winter than in summer. In contrast, the increased risk of SIDS associated with excess thermal insulation and bed sharing was less in winter than in summer. Prone sleeping position accounts for about half of the difference between the mortality rate in summer and that in winter. This suggests that some factor related to season modifies the effect of prone sleeping position.     

The 'modified prone position': a new approach for treating pre-vesical stones with extracorporeal shock wave lithotripsy

OBJECTIVE: To investigate the utility of a new 'modified-prone' position for treating pre-vesical stones with extracorporeal shock wave lithotripsy (ESWL), usually considered an acceptable and effective treatment for such stones, but for which many different body positions have been used in an attempt to increase its efficacy. PATIENTS AND METHODS: The study included 268 consecutive patients with a solitary pre-vesical stone who underwent ESWL either prone (69) or in the modified-prone position (199) between May 1999 and August 2001. Only those with one stone between the ureteric orifice and 1 cm proximal to the vesico-ureteric junction were included. In each case the stone diameter, days to stone clearance, number of shock waves applied per treatment, and number of sessions required to become stone-free were recorded. If the treatment failed this was also noted. Success rates in the prone and modified-prone groups were compared and analysed to assess which of the variables influenced success with ESWL. RESULTS: After ESWL, 95.5% of the 268 patients were stone-free; the rates in the prone and modified-prone groups were 89.9% and 97.5%, respectively (P = 0.015). The probability of success with ESWL therapy for pre-vesical calculi in modified-prone position was about five times (odds ratio 4.56, 95% confidence interval 1.2-17.7) greater than that expected with when prone. The modified-prone position was an independent factor most significantly influencing success with ESWL in these patients. CONCLUSION: The modified-prone position for ESWL is a new and very effective way to treat patients with pre-vesical stones.     

Pro/con clinical debate: the use of prone positioning in the management of patients with acute respiratory distress syndrome

Critical care medicine is a relatively new specialty and as such there is not a great deal of accumulated data to allow clinicians to practice ''evidence-based medicine'' in all situations they encounter. When evidence does exist, intensivists may choose not to follow it based on ''gut feelings'' or their own interpretation of how the data apply to their patient. It is perhaps not surprising that these latter events occur given that intensivists are often literally fighting for their patient''s lives. Prone positioning evokes a large emotional response from many intensivists. Despite accumulating data there appears to be two camps of clinicians: those who strongly believe in the therapy, and those who want more data. The emotion and rationale for the mindset of the two camps is evident in this issue of Critical Care Forum. With compelling arguments on both sides of the fence, it is apparent that this debate is far from over. The authors of this pro/con debate, which is based on a clinical scenario, first describe their position and then respond to their opponent''s position.     

A study of hepatitis C prevalence in healthcare workers in the West of Scotland

BACKGROUND AND AIMS: Whether healthcare workers have an increased prevalence of hepatitis C virus infection as a result of exposure to patient's blood and body fluids is controversial. This study assesses the prevalence of hepatitis C virus infection in healthcare workers, and its relation to the performance of exposure prone procedures and duration of occupational exposure, allowing an estimate to be made of the incidence of occupationally acquired hepatitis C infection among medical staff. METHODS: In this anonymous retrospective cohort study, we estimated the prevalence of hepatitis C infection in 10 654 healthcare workers. ELISA-3 testing was performed on pools of five sera collected during immunisation against hepatitis B. Healthcare workers were arranged into five occupational groups, according to the degree of patient exposure, and three age bands (<30 years, 30-39 years, >40 years). RESULTS: Prevalence of antibodies to hepatitis C was 0.28% (30/10 654), comparable in all occupational groups (p=0.34) and unrelated to duration of potential exposure. Assuming that all detected infections had been occupationally acquired, the maximum estimated risk of hepatitis C infection in exposure prone medical staff was low: 1.4% for surgeons and 1.0% for physicians over a 35 year professional career. CONCLUSIONS: Hepatitis C infection is infrequent in healthcare workers in Glasgow. Those conducting exposure prone procedures do not seem to be at higher risk than other healthcare staff.     

湖北省洪涝灾害易发地区居民重点传染病预防素养现状调查

目的了解湖北省洪涝灾害易发地区居民重点传染病预防素养水平。方法采用多阶段分层系统随机抽样的方法,对湖北省1区1县的居民进行问卷调查。结果洪涝灾害易发地区居民具备重点传染病预防素养的比例为4.1%,且在城乡、年龄和文化程度方面差异有统计学意义;具备重点传染病知识、相关健康生活行为方式、药品说明书阅读理解和相关行为操作4方面素养的比例分别为8.6%、44.8%、19.2%和9.5%;洪涝灾害易发地区居民认为有效的传染病知识传播渠道排名前3位为电视(76.2%)、看病时听医生讲(67.4%)和亲戚朋友介绍(55.6%)。结论洪涝灾害地区居民的传染病预防素养水平较低;应重点加强对农村地区居民、高年龄组、低文化程度群体和无灾时期的健康教育;当地的健康传播形式,应以电视传播和人际传播为主,其他形式为辅。     

改良俯卧位对俯卧位通气临床疗效及并发症的影响

目的观察改良俯卧位对俯卧位通气(PPV)临床疗效及并发症的影响。方法将该院呼吸和危重症医学科行PPV的52例患者随机分为对照组和实验组各26例,对照组应用常规方法进行PPV,实验组采用改良俯卧位进行PPV。比较两组患者PPV的临床效果和并发症发生情况。结果两组间俯卧位前和俯卧位后12 h的氧合指数无明显差异(P>0.05);两组患者俯卧位后12 h的氧合指数均较各组俯卧位前明显改善(P<0.05);两组患者气管插管脱出、血流动力学显著波动、误吸和面部水肿的发生率无显著差异(P>0.05);实验组皮肤压疮的发生率明显低于对照组(P<0.05)。结论改良俯卧位对PPV的临床疗效无显著影响,但可以降低皮肤压疮的发生率。     

不同体位肺复张对重症肺炎患者的临床治疗效果和安全性对比探讨

目的探讨不同体位肺复张对重症肺炎患者的临床治疗效果和安全性。方法选取本院收治的87例重症肺炎患者为研究对象,将患者分为仰卧位肺复张组和俯卧位肺复张组,分别使用不同的肺复张方法进行治疗,比较两组的临床效果。结果复张后5 min、1 h,两组患者的HR、CI、MAP与复张前比较,差异无统计学意义（P〉0.05）,复张后5 min的CVP与复张前比较,差异有统计学意义（P〈0.05）,复张后1 h与复张前比较,差异无统计学意义（P〉0.05）;复张后5 min、1 h的Pa O2/Fi O2高于复张前,差异有统计学意义（P〈0.05）。俯卧位肺复张组复张后5 min、1 h的Pa O2/Fi O2与仰卧位肺复张组比较,差异有统计学意义（P〈0.05）。在肺复张前后无一例患者出现气胸、皮下气肿等并发症;两组患者复张后5 min、1 h的胃黏膜p H与复张前比较,差异无统计学意义（P〉0.05）,两组患者复张后5 min、1 h的胃黏膜p H比较,差异无统计学意义（P〉0.05）。结论两种肺复张方法均能有效改善患者的血氧参数和呼吸功能,且俯卧位肺复张的效果稍显优势,需结合临床进行选择。