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Fulltext Effect of prone versus supine position in COVID-19 patients: A systematic review and meta-analysis

Chua EX, Zahir SMISM, Ng KT, Teoh WY, Hasan MS, Ruslan SRB, et al.

J Clin Anesth, 2021 Nov;74:110406.
PMID: 34182261 DOI: 10.1016/j.jclinane.2021.110406

STUDY OBJECTIVE: To review the effects of prone position and supine position on oxygenation parameters in patients with Coronavirus Disease 2019 (COVID-19).
DESIGN: Systematic review and meta-analysis of non-randomized trials.
PATIENTS: Databases of EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until March 2021.
INTERVENTIONS: COVID-19 patients being positioned in the prone position either whilst awake or mechanically ventilated.
MEASUREMENTS: Primary outcomes were oxygenation parameters (PaO₂/FiO₂ ratio, PaCO₂, SpO₂). Secondary outcomes included the rate of intubation and mortality rate.
RESULTS: Thirty-five studies (n = 1712 patients) were included in this review. In comparison to the supine group, prone position significantly improved the PaO₂/FiO₂ ratio (study = 13, patients = 1002, Mean difference, MD 52.15, 95% CI 37.08 to 67.22; p

Matched MeSH terms: Supine Position
Fulltext Clinical interpretations of the effectiveness of changes in body position during aerobic fitness after neurologic injury

Izan NF, Salleh SH, Ting CM, Noman F, Sh-Hussain H, Poznanski RR, et al.

J Integr Neurosci, 2020 Sep 30;19(3):479-487.
PMID: 33070527 DOI: 10.31083/j.jin.2020.03.222

The purpose is to estimate the effectiveness of electrocardiograms during resting and active participation by the differentiation between the electrical activity of the heart while standing and sitting in a resting state. The concern is to identify the electrocardiogram parameters that did not show significant changes within these positions. The electrocardiogram parameters can be considered to be a standard marker for medically compromised patients. The electrocardiogram is recorded in the standing and sitting positions focusing on healthy participants using standard electrode placement of lead-I. Combined lead-I patterns (camel-hump or ST-segment prolongation) are usually seen in neurologic injury or hypothermia patients. The pairwise comparisons of a year data are about 454,400 cycles of sitting and 493,470 cycles of standing data. Thus, it is essential to quantify the nature and magnitude of changes seen in the electrocardiogram with a change of posture from sitting to standing in a healthy individual. This makes the findings of electrocardiogram analysis in this paper interesting in which some parameters (i.e., camel-hump patterns in lead-I) are helpful for clinical interpretations and could be suggestive of neurologic injury.

Matched MeSH terms: Supine Position
Fulltext Ultrasonography measurement of inferior vena cava diameter of blood donors as predictors for early blood loss in tertiary hospital northeastern, Malaysia

Shaik Farid AW, Mohd Hashairi F, Nik Hisamuddin NA, Chew KS, Rashidi A

Med J Malaysia, 2013 Dec;68(6):465-8.
PMID: 24632914 MyJurnal

According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.

Matched MeSH terms: Supine Position
Comparison of Macintosh Laryngoscopy in Bed-up-Head-Elevated Position With GlideScope Laryngoscopy: A Randomized, Controlled, Noninferiority Trial

Tsan SEH, Lim SM, Abidin MFZ, Ganesh S, Wang CY

Anesth Analg, 2020 07;131(1):210-219.
PMID: 31348051 DOI: 10.1213/ANE.0000000000004349

BACKGROUND: Approximately half of all difficult tracheal intubations (DTIs) are unanticipated; hence, proper positioning during intubation is critical to increase the likelihood of success. The bed-up-head-elevated (BUHE) intubation position has been shown to improve laryngeal view, reduce airway complications, and prolong safe apneic time during intubation. In this study, we sought to determine whether the BUHE intubation position is noninferior to Glidescope (GLSC)-assisted intubation with regard to laryngeal exposure.
METHODS: A total of 138 American Society of Anesthesiologists (ASA) I to III patients were randomly assigned into 2 groups and underwent baseline laryngoscopy in the sniffing position. Group BUHE patients (n = 69) were then intubated in the BUHE position, while group GLSC patients (n = 69) were intubated using GLSC laryngoscopy. Laryngeal exposure was measured using Percentage of Glottic Opening (POGO) score and Cormack-Lehane (CL) grading, and noninferiority will be declared if the difference in mean POGO scores between both groups do not exceed -15% at the lower limit of a 98% confidence interval (CI). Secondary outcomes measured included time required for intubation (TRI), number of intubation attempts, use of airway adjuncts, effort during laryngoscopy, and complications during intubation.
RESULTS: Mean POGO score in group BUHE was 80.14% ± 22.03%, while in group GLSC it was 86.45% ± 18.83%, with a mean difference of -6.3% (98% CI, -13.2% to 0.6%). In both groups, there was a significant improvement in mean POGO scores when compared to baseline laryngoscopy in the sniffing position (group BUHE, 25.8% ± 4.7%; group GLSC, 30.7% ± 6.8%) (P < .0001). The mean TRI was 36.23 ± 14.41 seconds in group BUHE, while group GLSC had a mean TRI of 44.33 ± 11.53 seconds (P < .0001). In patients with baseline CL 3 grading, there was no significant difference between mean POGO scores in both groups (group BUHE, 49.2% ± 19.6% versus group GLSC, 70.5% ± 29.7%; P = .054).
CONCLUSIONS: In the general population, BUHE intubation position provides a noninferior laryngeal view to GLSC intubation. The laryngeal views obtained in both approaches were superior to the laryngeal view obtained in the sniffing position. In view of the many advantages of the BUHE position for intubation, the lack of proven adverse effects, the simplicity, and the cost-effectiveness, we propose that clinicians should consider the BUHE position as the standard intubation position for the general population.

Matched MeSH terms: Supine Position/physiology*
Effect of turning vs. supine position under phototherapy on neonates with hyperbilirubinemia: a systematic review

Lee Wan Fei S, Abdullah KL

J Clin Nurs, 2015 Mar;24(5-6):672-82.
PMID: 25319831 DOI: 10.1111/jocn.12712

To determine the most effective position jaundiced neonates should assume during phototherapy from appraised randomised controlled trials.

Matched MeSH terms: Supine Position
Fulltext Standing beat-to-beat blood pressure variability is reduced among fallers in the Malaysian Elders Longitudinal Study

Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP

Medicine (Baltimore), 2017 Oct;96(42):e8193.
PMID: 29049203 DOI: 10.1097/MD.0000000000008193

The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.

Matched MeSH terms: Supine Position/physiology
Effect of prolonged supine position on the intraocular pressure in patients with obstructive sleep apnea syndrome

Fang SY, Wan Abdul Halim WH, Mat Baki M, Din NM

Graefes Arch Clin Exp Ophthalmol, 2018 Apr;256(4):783-790.
PMID: 29492688 DOI: 10.1007/s00417-018-3919-7

PURPOSE: Obstructive sleep apnea syndrome (OSAS) patients are at risk of glaucoma but the risk increases if they have higher intraocular pressure (IOP) while sleeping. We aim to evaluate the postural effect of upright and prolong supine positions on IOP in these patients.
METHODS: This is a cross-sectional study involving 27 patients with symptoms of OSAS seen at a tertiary institutional center and 25 normal controls performed between June 2015 and June 2016. All patients and controls underwent a polysomnography (PSG) test and were diagnosed with OSAS based on the apnea-hypopnea index (AHI). Patients are those with OSAS symptoms and had AHI > 5, whereas controls are staffs from the ophthalmology clinic without clinical criteria for OSAS and had PSG result of AHI

Matched MeSH terms: Supine Position/physiology*
Fulltext Four nucleotide deletions of exon 47 in Dystrophin gene: a case report of a Kelantanese Duchenne Muscular Dystrophy patient

Fatimah Azman, Rose Adzrianee Adnan, Norhafizah Che Abdul Razak, Nazihah Mohd Yunus, Sarina Sulong, Rozita Abdullah, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(202):11-13.
MyJurnal

Muscular dystrophy is a group of diseases that result in progressive muscle weakness and atrophy. Duchenne Muscular Dystrophy (DMD) is classified as dystrophinopathy and is an X-linked recessive disease. It is caused by alterations in the dystrophin gene at Xp21.2 encoding 79 exons [1]. It is characterised by progressive muscle wasting that begins at 3 to 5 years, delay in motor development and eventually wheelchair confinement followed by premature death at about 30 years from cardiac or respiratory complications [2]. Genetic etiology of cases of DMD in Malaysia are still scarcely reported. Here, we report the genetic cause in the case of an 11-year-old Kelantanese Malay boy who has progressive muscle weakness since 5 years old. He has difficulty in getting up from sitting and supine position also in climbing up stairs until 1st floor. He has a strong family history of DMD and musculoskeletal problems. His younger brother was diagnosed with DMD by molecular analysis and his maternal uncle died at the age of 16 with musculoskeletal problems but was never investigated. Physical examination revealed no dysmorphic features, positive Gower sign with absent tounge fasciculation. On neurological examination, tendon reflexes and muscle tone for limbs were normal. Muscle power for bilateral upper limbs were normal, however, bilateral lower limbs showed slight reduction in muscle power with calf hypertrophy.

Matched MeSH terms: Supine Position
Fulltext Pulled/nursemaid's elbow

Mohd Miswan MF, Othman MS, Muhamad Effendi F, Ibrahim MI, Rozali KN

Malays Fam Physician, 2017;12(1):26-28.
PMID: 28503271

Nursemaid's elbow is a radial head subluxation caused by axial traction on the extended arm while the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that the child was moving the right upper limb less often and there was tenderness over the right elbow. X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of conservative management was decided upon and the patient was placed on a right elbow backslab with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or neurological deficit noted. A repeate x-ray revealed normal findings.

Matched MeSH terms: Supine Position
Fulltext Pulled/nursemaid’s elbow

Mohd Miswan M. F., Mohamad Saifudin Othman, Ferdhany Muhamad Effendi, Khairul Nizam Rozali, Mohd Ikraam Ibrahim

Malays Fam Physician, 2017;12(1):26-28.
MyJurnal

Nursemaid’s elbow is a radial head subluxation caused by axial traction on the extended arm while
the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with
pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that
the child was moving the right upper limb less often and there was tenderness over the right elbow.
X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of
conservative management was decided upon and the patient was placed on a right elbow backslab
with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or
neurological deficit noted. A repeate x-ray revealed normal findings.

Matched MeSH terms: Supine Position
Fulltext Unintentional injury and its prevention in infant: knowledge and self-reported practices of main caregivers

Ramdzan SN, Liew SM, Khoo EM

BMC Pediatr, 2014;14:132.
PMID: 24885332 DOI: 10.1186/1471-2431-14-132

BACKGROUND:
Unintentional injuries are the major cause of morbidity and mortality in infants. Prevention of unintentional injuries has been shown to be effective with education. Understanding the level of knowledge and practices of caregivers in infant safety would be useful to identify gaps for improvement.

METHODS:
A cross-sectional study was conducted in an urban government health clinic in Malaysia among main caregivers of infants aged 11 to 15 months. Face-to-face interviews were conducted using a semi-structured self-designed questionnaire. Responses to the items were categorised by the percentage of correct answers: poor (<50%), moderate (50% - 70%) and good (>70%).

RESULTS:
A total of 403 caregivers participated in the study. Of the 21 items in the questionnaire on knowledge, 19 had good-to-moderate responses and two had poor responses. The two items on knowledge with poor responses were on the use of infant walkers (26.8%) and allowing infants on motorcycles as pillion riders (27.3%). Self-reported practice of infant safety was poor. None of the participants followed all 19 safety practices measured. Eight (42.1%) items on self-reported practices had poor responses. The worst three of these were on the use of baby cots (16.4%), avoiding the use of infant walkers (23.8%) and putting infants to sleep in the supine position (25.6%). Better knowledge was associated with self-reported safety practices in infants (p < 0.05). However, knowledge did not correspond to correct practice, particularly on the use of baby cots, infant walkers and sarong cradles.

CONCLUSION:
Main caregivers' knowledge on infant safety was good but self-reported practice was poor. Further research in the future is required to identify interventions that target these potentially harmful practices.

Matched MeSH terms: Supine Position