1984 THE EFFECT OF PRONE-FLEXED POSITIONING ON AIRWAY PRESSURES DURING PERCUTANEOUS NEPHROLITHOTOMY (PCNL)
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Résumé
You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (IV)1 Apr 20131984 THE EFFECT OF PRONE-FLEXED POSITIONING ON AIRWAY PRESSURES DURING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) Kirsten Foell, Michael Ordon, Andrea Lantz, Kenneth T Pace, and R John D'A Honey Kirsten FoellKirsten Foell Toronto, Canada More articles by this author , Michael OrdonMichael Ordon Toronto, Canada More articles by this author , Andrea LantzAndrea Lantz Toronto, Canada More articles by this author , Kenneth T PaceKenneth T Pace Toronto, Canada More articles by this author , and R John D'A HoneyR John D'A Honey Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2403AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prone-flexed position (PFP) for PCNL involves 40-60 degree flexion of the lumbar spine and 15 degree flexion at the knees. The advantages over the prone position (PP), as shown in one of our studies involving CT measurements, include widening of the space between the 12th rib and iliac crest, increased distance between the tract and the spleen or liver, lowering of the kidneys relative to the ribs, and shortening of the skin-to-stone distance. However, urologists unfamiliar with the PFP have questioned the effect of abdominal compression on airway pressure and ventilation. The objectives of this study were to quantify the changes in peak airway pressure (PAP) in the supine (SP), PP and PFP, and to determine the relationship between abdominal girth, body mass index (BMI) and PAP. METHODS Measurements involving consecutive patients undergoing PCNL in the PFP were prospectively recorded from Mar. to Oct. 2012. After intubation and muscle paralysis, the PAP and positive end-expiratory pressure (PEEP) were recorded in the SP, PP, and PFP. The PAPs (after subtracting PEEP) across the 3 positions for each patient were compared with repeated measure ANOVA. The paired t-test was used to compare the differences between SP and PFP across obese (BMI>30) and non-obese patients. To assess if abdominal girth was a predictor of change in PAP from SP to PFP, linear regression was utilized. RESULTS 42 patients (71% male, 29% female) were included. All PAPs were <35 cmH2O. The mean PAP was significantly higher in the PFP (20.5±0.7 cmH2O) than PP (17.2±0.6 cmH2O, p<0.001), which was higher than in the SP (15.4±0.6 cmH2O, p<0.001). The mean BMI was 28.3±5.2 kg/m2, and abdominal girth was 101±12 cm. The mean change in PAP when moving from the SP to PFP did not differ significantly in the obese (n=15) vs. non-obese (n=27) population (p=0.21). Abdominal girth was not a significant predictor of the change in PAP from SP to PFP (linear regression, p=0.23), however, girth was a significant predictor of elevated PAP in the PFP (p=0.024). Importantly, none of the patients required conversion out of the PFP for anesthetic or other reasons. CONCLUSIONS The airway pressures experienced in the prone-flexed position are significantly higher than when prone or supine, particularly in those with large abdominal girths. However, this elevation is not clinically significant, as all airway pressures remained <35 cmH2O and no patients required conversion to an alternate position. Given the anatomical and surgical advantages, prone-flexed remains our preferred position for PCNL and is safe, even in obese patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e814 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirsten Foell Toronto, Canada More articles by this author Michael Ordon Toronto, Canada More articles by this author Andrea Lantz Toronto, Canada More articles by this author Kenneth T Pace Toronto, Canada More articles by this author R John D'A Honey Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».