Recovery Position Research Articles

Supraglottic jet oxygenation and ventilation improves oxygenation during endoscopic retrograde cholangiopancreatography: a randomized controlled clinical trial

PurposeHypoxia is one of the most frequent adverse events under deep sedation in the semiprone position. We hypothesized that supraglottic jet oxygenation and ventilation (SJOV) via Wei nasal jet tube (WNJ) can reduce the incidence of hypoxia in patients under deep sedation during endoscopic retrograde cholangiopancreatography (ERCP).MethodsA total of 171 patients were divided into three groups: N group, supplementary oxygen via a nasopharyngeal airway (4–6 L/min); W group, supplementary oxygen via WNJ (4–6 L/min); WS group, SJOV via WNJ. The primary outcome was the incidence of adverse events, including sedation-related adverse events [SRAEs, hypoxemia (SpO2 = 75–89% lasted less than 60 s); severe hypoxemia (SpO2 < 75% at any time or SpO2 < 90% lasted more than 60 s] and subclinical respiratory depression (SpO2 = 90–95%). Other intraoperative and post-operative adverse events were also recorded as secondary outcomes.ResultsCompared with the N group, the incidence of hypoxemia and subclinical respiratory depression in the WS group was significantly lower (21% vs. 4%, P = 0.005; 27% vs. 6%, P = 0.002). Compared with Group W, the incidence of hypoxemia and subclinical respiratory depression in Group WS was also significantly less frequent (20% vs. 4%, P = 0.009; 21% vs. 6%, P = 0.014). No severe hypoxia occurred in the group WS, while four and one instances were observed in the group N and group W respectively. There were no significant differences in other adverse events among the three groups.ConclusionSJOV can effectively improve oxygenation during ERCP in deeply sedated semiprone patients.

10159-STMO-7 INTRAOPERATIVE MRI SURGERY FOR POSTERIOR FOSSA LESIONS

Abstract Background: Intraoperative MRI (iMRI) is an important modality in brain tumor surgery to identify residual tumors, however, it is problematic due to patient positional limitations. In this study, we investigated the usefulness of iMRI for posterior fossa lesions. Materials and Methods: Of 320 cases of brain tumors removed using iMRI from June 2016 to April 2023, 24 cases of posterior fossa lesions were included. Tumor type, approach method, imaging availability, tumor removal rate, and complications were examined retrospectively. Results: Tumor types included 8 gliomas, 5 epidermoid cysts, 4 meningiomas, 3 metastatic brain tumors, 1 schwannoma, and 3 others. Eleven patients underwent midline suboccipital approach in the supine position, 8 patients underwent lateral suboccipital approach, 2 patients underwent occipital transtentorial approach, and 2 patients underwent anterior transpetrosal approach in the supine position. transpetrosal approach in 2 cases and subtemporal approach in 1 case. iMRI showed residual lesion in 14 of 24 patients. More than half of the gliomas and epidermoid cysts had intraoperative residual disease, whereas only one meningioma did. Total resection was achieved except for one case of intentional residual schwannoma and two cases of glioma. Discussion: iMRI requires the upper body to fit within a gantry, and it is difficult to image in the park bench position. However, various approaches is possible by using a supine-lateral or semi-prone position. In the concorde position, where the fourth ventricle and upper cerebellum are approached, it is useful to insert a mat in the anterior thoracic and raise the upper body. For tumors in the dorsal brainstem and upper cerebellum, the occipital transtentorial approach was used. iMRI is effective in the removal of all tumors, including gliomas in intramedullary tumors and epidermoid cysts in extramedullary tumors. Conclusion: iMRI can be used in posterior cranial fossa lesions.

TERI: An Effective Framework for Trajectory Recovery with Irregular Time Intervals

The proliferation of trajectory data has facilitated various applications in urban spaces, such as travel time estimation, traffic monitoring, and flow prediction. These applications require a substantial volume of high-quality trajectories as the prerequisite to achieve effective performance. Unfortunately, a large number of real-world trajectories are inevitably collected in unsatisfactory quality due to device constraints. To address this issue, previous studies have proposed numerous trajectory recovery methods to augment the quality of such trajectories, thereby ensuring the performance of related applications. However, these methods all assume the awareness of the recovery positions in advance, which is a condition not always available in practice. In this paper, we discard this strong assumption and focus on trajectory recovery with irregular time intervals as a more prevalent setting in downstream scenarios. We propose a novel framework, called TERI, to tackle trajectory recovery without prior information in a two-stage process, where recovery positions are first detected, followed by the imputation of the missing data points. In each stage, TERI framework deploys a model named RETE, which is based on Transformer encoder architecture enhanced by novel designs to boost the performance for the new problem setting. Specifically, RETE features a learnable Fourier encoding module to better model spatial and temporal correlations, and integrates collective transition pattern learning and trajectory contrastive learning to effectively capture sequential transition patterns. Extensive experiments on three real-world datasets demonstrate that TERI consistently outperforms all the baselines by a significant large margin.

220 Learning to place in Recovery Position by 10–11 year-old schoolchildren: a descriptive study

220 Learning to place in Recovery Position by 10–11 year-old schoolchildren: a descriptive study

Nursing First Aid to Emergency Events in Agricultural Areas: Literature Review

Being a farmer who works directly in the environment certainly has many risks at work, one of which is the occurrence of unwanted events that can threaten the health of farmers. Some problems are classified as emergencies and must be handled immediately to avoid fatalities. One example is the occurrence of snake bite emergencies in farmers. This study aims to determine some emergencies in agricultural areas and how to provide first aid. The method used in this study was a literature review of articles from article search engines such as PubMed, Google Scholar, and Science Direct analyzed using the PRISMA technique by including articles published in the last five years. The results found that emergencies that often occur in agricultural areas include venomous snake bites, pesticide poisoning, contracting dengue fever from mosquitoes, and rat bites that cause rat-bite fever. First aid methods that can be performed on someone whom a snake has bitten are by calming the victim, immobilizing the victim's entire body by laying him in the recovery position and immobilizing the affected body part using either a sling, splint, or pressure bandage immobilization (PBI) method. Nurses have a role in educating and counseling farmers on how to first aid someone who experiences snake bites, rat bites that cause rat bite fever, and drowning in fishermen.

368. UNIPORTAL VATS MCKEOWN ESOPHAGECTOMY FOR LOWER THIRD ESOPHAGEAL SQUAMOUS CELL CANCER

Abstract https://wetransfer.com/downloads/bc83bc97967d74f093629397fd7b5ed720230505000919/8c1e7aa0e8a6b089152303025bfbfd7120230505000947/ff511d Background Minimally invasive esophagectomy has become the standard surgical procedure for the carcinoma esophagus worldwide. It is performed with multiport VATS or robotically. Uniport VATS technique has gained a recent popularity among thoracic surgeons for resecting lung cancers. Here we describe our technique of performing uniportal McKeown esophagectomy in semi prone position without using carbon dioxide. Methods The surgery was performed on a middle aged male patient who was diagnosed with a locally advanced squamous cell cancer of lower third of the esophagus. Multidisciplinary meeting planned three cycles of Docetaxel, cisplatin and 5 fluorouracil regimen and subsequent surgery was planned after patient had a partial response. Results The thoracic phase was performed by uniport VATS and abdominal phase was performed by standard multiport technique. Neck anastomosis was performed with linear stapler in side to side manner. Total time of the surgery was 280 minutes. Intraoperative and postoperative period was uneventful. Patient was discharged home on ninth postoperative day on oral diet. Conclusion Uniportal VATS McKeown Esophagectomy is a feasible and safe technique with all short term advantages of minimally invasive approach. The coaxial ergonomics together with the semi prone positioning, allows the best surgical maneuvering.

405. SHORT-TERM OUTCOMES OF ROBOT-ASSISTED ESOPHAGECTOMY

Abstract Background Robot-assisted minimally invasive esophagectomy (RAMIE) has become widely performed in Japan, and the technique and short-term results have been accumulated. In our institute, we started with daVinci S in 2013, switched to Xi in 2018, and have experienced 110 cases so far. Method; Technique and Devices: Semi-prone position with the left upper extremity placed under the body, 4 ports +1 assist port (Air Seal), double bipolar system—is the basic approach. The right upper extremity is placed so that it is attached to the head to provide axillary working space, and orthoglass to avoid direct compression of the right upper arm and robotic 4th arm. The range of motion of the 4th arm in the lower mediastinum is limited by the patient’s physique, so assistant forceps are used to assist as needed. Be willing to invert the camera to view the back of the operative field. Intraoperative recurrent nerve monitoring (NIM) was used in all cases. Results Five surgeons have performed RAMIE procedures. There have been no cases of conversion to thoracoscopic or open thoracotomy. The thoracic procedure time was significantly longer in RAMIE (299 min:274 min) than in thoracoscopic MIE. Blood loss tended to be less (17.1 mL: 44.0 mL). The incidence of recurrent nerve palsy (CD grade I or higher) was 44%:37%, that of pneumonia (CD grade II or higher) was 19%:18% and perioperative complications were similar between the two groups. Comparing the first half of the period when RAMIE was initiated with the second half, there was a significant decrease in the amount of bleeding, surgery time, and incidence of pneumonia, indicating an improvement in technique due to the number of experienced cases. Conclusion RAMIE can be performed safely, although no clear advantages can be demonstrated compared to thoracoscopic MIE at this time. RAMIE has clear advantages in terms of visual magnification of the dissected layer and stability of the surgical field, therefore, it is expected to reduce complications due to improved technique.

259. ROBOTIC ESOPHAGECTOMY AND THREE FIELD LYMPHADENECTOMY WITH INTRA-OPERATIVE RECURRENT LARYNGEAL NERVE MONITORING

Abstract https://www.dropbox.com/s/uu8gju382tkch29/3FTTE_ISDE_SJ_0423.mp4?dl&amp;#x003D;0. Background Surgery for esophageal malignancy is associated with significant morbidity and mortality, especially in cases requiring extensive lymphadenectomy. Recurrent laryngeal nerve (RLN) injury can result in hoarseness, aspiration, pneumonia, tracheostomy, and could even be life-threatening. A 33 year old lady with a lower thoracic esophageal squamous carcinoma with left trachea-esophageal groove nodes in the superior mediastinum underwent a Xi robotic esophagectomy and three field lymphadenectomy with intra-operative recurrent laryngeal nerve monitoring after neoadjuvant chemotherapy. Methods We used a bronchial blocker (COOPDECH bronchial blocker, Daiken-Iki Corporation, Japan) with a single-lumen electromyographic (EMG) endotracheal tube) (NIM EMG endotracheal tube, Medtronic Xomed, Jacksonville, FL, USA) for lung isolation along with capnothorax. Semiprone position with 3 robotic ports and an assistant port was utilised. Nerve monitoring provided an audiovisual waveform when either the vagus or the RLN was stimulated and transformed the laryngeal muscle activity into EMG signals. Grounding electrodes were placed on the patient’s shoulder or near the sternum. A prerequisite for adequate and effective nerve monitoring is the avoidance of neuromuscular blockers during anesthesia. Results Esophageal mobilisation was done in the standard fashion. The lymphadenectomy along the recurrent laryngeal nerves in the mediastinum and neck was guided by the nerve identification and stimulation utilising the long intra-thoracic nerve monitoring probes. In the mediastinum, the right recurrent laryngeal nerve was identified taking off from the right vagus along the lateral border of the trachea and looping around the right subclavian artery. The thoracic left recurrent nerve was identified in the aorto-pulmonary window as well along the left lateral border of the trachea in the trachea-esophageal groove where the metastatic lymph nodes were identified on radiology. Conclusion Minimally invasive esophagectomy is now the preferred modality for surgical extirpation of esophageal malignancies, with extensive lymphadenectomy used in appropriate cases. Interventions to reduce postoperative morbidity resulting from the dissection of nodes around the RLN need to be used. The use of IONM is associated with lower RLN palsy rates and superior lymph nodal yield and needs to be investigated with large-scale randomized studies for beneficial clinical outcomes.

Outcomes and evaluation of endoscopic retrograde cholangiopancreatography via Gastro-Laryngeal Tube in adult patients: a prospective randomised control study

ABSTRACT Objectives In conventional endoscopic retrograde cholangiopancreatography (ERCP), the patient lies prone or in a semi-prone position under deep sedation and maintains spontaneous ventilation. Sedative-induced respiratory depression and unprotected airway compromise patients’ safety. The gastro-laryngeal tube (G-LT) is a novel reusable supraglottic airway device with two separate ports for endoscopy and ventilation. This study attempts to evaluate the performance characteristic of G-LT. Methods One hundred and forty patients undergoing ERCP were enrolled and randomized. In Group G, patients underwent ERCP with G-LT, whereas Group S patients underwent ERCP conventionally. G-LT insertion attempts, esophageal visualization times, vital parameters, propofol consumption, endoscopists’ and anesthesiologists’ satisfaction scores, time to achieve Modified Aldrete Score of ≥ 9, and complications were recorded. Results Both groups showed similar demographic parameters and 100% procedure completion rates. G-LT group showed shortened esophageal visualization times (4.71 ± 1.687 s vs 7.37 ± 1.515 s) and increased propofol consumption (423.14 ± 106.982 mg vs 178.00 ± 100.125 mg). Group G showed better endoscopic maneuvrability and lesser hemodynamic variability. Sore throat, dysphagia, and mucosal trauma were higher in the G-LT group. Conclusion G-LT provides less intra-procedural hemodynamic changes, quicker esophageal visualization, and better scope maneuvrability at the cost of higher propofol consumption, sore throat, dysphagia, and mucosal trauma. Trial Registration Clinical Trial Registry of India CTRI/2021/06/034212 (Registered on: 14/06/2021)

Physician Assistant familiarity and skill with the recovery position: A pilot study

Abstract Introduction Prior to matriculation, physician assistant students often need to be certified in Basic Life Support. However, it is unknown whether they are aware of and can place a victim in one specific life-saving method, the recovery position. This study evaluated physician assistant students’ ability to place a human victim in the recovery position. Methods Students enrolled in the physician assistant program (MSBS-PA) at a midwestern university, entered a simulated, multi-victim scene where they encountered a live victim with a head wound and difficulty breathing, laying supine on the ground, and had to provide care they felt necessary to save their life. The students were randomly selected from the university physician assistant program. Results Just 38.4% (10/26) of students successfully placed the victim in the recovery. While some stated awareness of the recovery position, the majority stated that they had never received training nor had to demonstrate competency. Conclusion The findings support the need to provide recovery position training to physician assistant students so they may better respond to a multi-victim incident.

Acoustic Roughness Measurement of Railway Tracks: Running Surface Detection and Compensation of Lateral Movements for Optical Measurements on a Train.

Rolling noise is a significant contributor to railway noise. Wheel and rail roughness are decisive for the emitted noise level. An optical measurement method installed on a moving train is suitable for closer monitoring of the rail surface condition. A measurement setup based on the chord method requires the sensors to be positioned in a straight line along the direction of measurement and in a stable lateral position. Measurements should always be performed within the shiny and uncorroded running surface, even when there are lateral movements of the train. In this study, concepts for the detection of the running surface and the compensation of lateral movements are investigated in a laboratory setting. The setup consists of a vertical lathe with a ring-shaped workpiece that incorporates an implemented artificial running surface. The detection of the running surface based on laser triangulation sensors and a laser profilometer is investigated. It is shown that the running surface can be detected using a laser profilometer that measures the intensity of the reflected laser light. It is possible to detect the lateral position and the width of the running surface. A linear positioning system is proposed to adjust the lateral position of the sensors based on the running surface detection of the laser profilometer. When the lateral position of the measuring sensor is disturbed by a movement with a wavelength of 18.85 m, the linear positioning system can keep the laser triangulation sensor inside the running surface for 98.44% of the measured data points at a velocity of approximately 7.5 km h-1. The mean positioning error is 1.40 mm. By implementing the proposed system on the train, future studies can be conducted to examine the lateral position of the running surface as a function of the various operational parameters of the train.

The Impact of Maternal Position in Labor on Occiput-Posterior Position of Fetus and Pregnancy Outcomes in Pregnant Women Without Epidural Analgesia.

Fetal occiput posterior (OP) position is associated with more maternal and neonatal complications. This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes. This randomized clinical trial study included 180 primigravida women in labor with a single fetus and approved OP position. Participants were randomly allocated into three groups: semi-prone position (n=45), knee-chest position (n=45), and supine position (n=90). All participants were placed in the defined positions 15-30 min in labor until delivery. Data collected using Visual Analogue Scale and researcher made checklist. The ANOVA, Tukey post hoc, and the chi-square test were used to analyze. Among all participants who had OP, after intervention 16.3% in the semi-prone position, 14/3 % in the knee-chest position, and 33.7% of the control groups remained with OP at birth (X3=7/87, P=0.019). The rate of natural delivery was significantly higher in the semi-prone position and knee-chest position. The duration of active phase of labor and low back pain were significantly reduced in the semi-prone and knee-chest position compared to the control groups (P<0.05). There were no differences in the duration of the third stage of labor, APGAR score, and the rate of neonatal addition to neonatal intensive care unit, using oxytocin, and perineal tears (P>0.05). The semi-prone and knee-chest positions increase the spontaneous rotation of occiput to the anterior position, vaginal delivery rates as well as a reduction in duration of active phase of labor and low back pain after delivery.

Variation in cardiopulmonary restoration due to bodily posture post-submaximal exercise in collegiate athletes.

The body's anatomical position can influence the autonomic response to return to homeostasis following high intensity exercise. Discrepancies exist as to which body position is considered optimal and practical. This study intends to examine three recovery positions post submaximal exercise to determine which body position would be the most efficient in terms of excess post-exercise oxygen consumption and heart rate recovery. NCAA Division I athletes (N.=17) from multiple sport teams completed three submaximal exercise tests utilizing the Bruce Protocol. Excess post-exercise oxygen consumption and heart rate recovery were measured at peak exercise and at 1-, 5-, and 10-minute time intervals during the recovery phase while assuming a recovery position: supine, trunk forward leaning, and standing vertical. Statistical analysis showed the 1-minute excess post-exercise oxygen consumption associated with supine recovery (1725±348 mL/kg) was significantly greater than standing vertical (1578±340 mL/kg, P=0.024). At 5 minutes, supine excess post-exercise oxygen consumption (3557±760 mL/kg) was significantly less than trunk forward leaning (4054±777 mL/kg, P=0.0001) and trunk forward leaning was significantly greater than standing vertical (3776±700 mL/kg, P=0.008). At 10 minutes, supine excess post-exercise oxygen consumption (5246±961 mL/kg) was significantly less than both the standing vertical position (5878±1042 mL/kg, P=0.0099), and the trunk forward leaning position (6749±1223 mL/kg, P<0.0001). Supine had the highest heart rate recovery at 1-, 5-, and 10-minutes post exercise. The supine position proved to be the most optimal during the 10-minute recovery period, while the trunk forward leaning position showed to be a more advantageous position for short-term recovery.

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

Introduction of recovery position training to healthcare students

Healthcare students often need Basic Life Support certification. Does this include the recovery position? This study evaluated healthcare students' ability to place a victim into the recovery position. Participants entered a simulated, multi-victim active shooting scene and had to care for a human victim. 16.9% of nursing students placed the victim in the recovery position, compared to 11.1% of non-nursing students. The findings support recovery position training to better respond to a multi-victim incident.

Numerical investigation of extracted position characteristics in porous media with lean methane and air premixtures combustion

Hydrogen production through steam generated from low-grade fuel recovery is considered a prospective method. To maximize the energy recovery, the influence of the heat exchanger position on the heat extraction stability of lean methane-air premixtures combustion in a porous burner has been numerically explored. The extracted position coefficient (EPC) is defined and a heat extraction model is validated through the experimental findings. It is shown that extracted position has a significant influence on the temperature profile, heat transfer capacity, heat loss as well as heat recovery rate. When the EPC is lower than 0.18, the filtration burner shows worse stability with great heat loss, the heat transfer behavior of the heat exchange tubes is severely weakened and heat recovery efficiency is merely about 13%. The optimal heat recovery position is recommended in the EPC range of 0.36–0.55, which has shown excellent heat extraction performance and accelerated the process of acquiring a quasi-steady state. Within this EPC range, the fluctuation of outlet temperature difference can be stabilized within 0.2 K, which maximizes the heat flux of heat exchangers, and heat recovery efficiency of about 70%–89% recovered with a concentration of 0.4%–0.8%.

Assessing bystander first aid: development and validation of a First Aid Quality Assessment (FAQA) tool

BackgroundInjuries are one of the leading causes of death worldwide. Bystanders at the scene can perform first aid measures before the arrival of health services. The quality of first aid measures likely affects patient outcome. However, scientific evidence on its effect on patient outcome is limited. To properly assess bystander first aid quality, measure effect, and facilitate improvement, validated assessment tools are needed.The purpose of this study was to develop and validate a First Aid Quality Assessment (FAQA) tool. The FAQA tool focuses on first aid measures for injured patients based on the ABC-principle, as assessed by ambulance personnel arriving on scene.MethodsIn phase 1, we drafted an initial version of the FAQA tool for assessment of airway management, control of external bleeding, recovery position and hypothermia prevention. A group of ambulance personnel aided presentation and wording of the tool. In phase 2 we made eight virtual reality (VR) films, each presenting an injury scenario where bystander performed first aid. In phase 3, an expert group discussed until consensus on how the FAQA tool should rate each scenario. Followingly, 19 respondents, all ambulance personnel, rated the eight films with the FAQA tool. We assessed concurrent validity and inter-rater agreement by visual inspection and Kendall’s coefficient of concordance.ResultsFAQA-scores by the expert group concurred with ± 1 of the median of the respondents on all first aid measures for all eight films except one case, where a deviation of 2 was seen. The inter-rater agreement was “very good” for three first aid measures, “good” for one, and “moderate” for the scoring of overall quality on first aid measures.ConclusionOur findings show that it is feasible and acceptable for ambulance personnel to collect information on bystander first aid with the FAQA tool and will be of importance for future research on bystander first aid for injured patients.

Assessing the weak links – Necessity and impact of regional cardiac arrest awareness campaigns for laypersons

IntroductionPublic knowledge of out-of-hospital cardiac arrest (OHCA), and initiation of basic life support (BLS) is crucial to increase survival in OHCA. MethodsThe study analysed the knowledge and willingness to perform BLS of laypersons passing an AED at a public train station. Interviewees were recruited at two time points before and after a four year-long structured regional awareness campaign, which focused on call, compress, shock in a mid-size European city (270,000 inhabitants). Complete BLS was defined as multiple responses for call for help; initiation of chest compressions; and usage of an AED, without mentioning recovery position. Minimal BLS was defined as call for help and initiation of chest compressions. ResultsA total of 784 persons were interviewed, 257 at baseline and 527 post-campaign. Confronted with a fictional OHCA, at baseline 8.5% of the interviewees spontaneously mentioned actions for complete BLS and 17.9% post-campaign (p = 0.009). An even larger increase in knowledge was seen in minimal BLS (34.6% vs 60.6%, p < 0.001). ConclusionAfter a regional cardiac arrest awareness campaign, we found an increase in knowledge of BLS actions in the lay public. However, our investigation revealed severe gaps in BLS knowledge, possibly resulting in weak first links of the chain of survival.

Thoracoscopic enucleation of esophageal leiomyoma in semi-prone position: how I do it

Thoracoscopic enucleation of esophageal leiomyoma in semi-prone position: how I do it

Uniportal video-assisted thoracoscopic surgery in semi-prone position utilising direct endobronchial intubation for oesophagus leiomyoma excision.

Leiomyomas are the most common benign tumours of oesophageal smooth muscle origin. In this era of constantly evolving medical technology, video-assisted, robot-assisted and endoscopic approaches are the minimally invasive strategies for the excision of these lesions. Here, we report our modification of this surgery. The lesion was excised with uniportal video-assisted thoracoscopic surgery in a semi-prone position with single-lumen endobronchial intubation.