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John S Ebersole - One of the best experts on this subject based on the ideXlab platform.
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association of Prone Position with sudden unexpected death in epilepsyauthor response
Neurology, 2015Co-Authors: Nitin K Sethi, Jennifer Liebenthal, Shasha Wu, Sandra Rose, Samden D Lhatoo, Lina Nashef, Torbjorn Tomson, Philippe Ryvlin, John S EbersoleAbstract:Editors' Note: “Association of Prone Position with sudden unexpected death in epilepsy” raised several inquiries from our readers. Sethi suggests that since the pathogenesis of sudden unexpected death in epilepsy (SUDEP) is not yet elucidated, advising patients to sleep in the supine Position, which risks aspiration, warrants careful consideration. Furthermore, based on their prior study, Lhatoo et al. believe that forced ictal version, rather than Prone Position, may be a SUDEP risk factor. Authors Tao et al. argue that supine sleeping can help prevent SUDEP and, although it could be associated with aspiration, babies seizing face-down risk suffocation. —Chafic Karam, MD, and Robert C. Griggs, MD Liebenthal et al.1 studied the association of Prone Position with sudden unexpected death in epilepsy (SUDEP). The central dogma underlying SUDEP is unclear. Does postictal cerebral shutdown represented by postictal generalized EEG suppression (PGES) cause hypoxemia, hypercapnia, pulmonary edema, and autonomic instability, resulting in death? It is also possible that the primary peri-ictal involvement of brainstem neurons (pre-Botzinger complex) sets off the cascade that manifests as PGES at the end of a terminal seizure. …
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association of Prone Position with sudden unexpected death in epilepsy
Neurology, 2015Co-Authors: Jennifer Liebenthal, Shasha Wu, Sandra Rose, John S EbersoleAbstract:Objective: To examine the association between Prone Position and sudden unexpected death in epilepsy (SUDEP). Methods: We conducted a systematic review and meta-analysis based on a literature search from databases PubMed, Web of Science, and Scopus, using keywords “SUDEP” or “sudden unexpected death in epilepsy” or “sudden unexplained death syndromes in epilepsy.” Twenty-five publications met the inclusion and exclusion criteria and were enrolled in this study. Results: Body Positions were documented in 253 cases of SUDEP. Of these patients, 73.3% (95% confidence interval [CI] = 65.7%, 80.9%) died in the Prone Position, whereas 26.7% (95% CI = 16.3%, 37.1%) died in nonProne Positions. Binary random-effects analysis showed that Prone Position is significantly associated with SUDEP, as compared with nonProne Position ( p p = 0.009). Conclusion: There is a significant association between Prone Position and SUDEP, which suggests that Prone Position is a major risk factor for SUDEP, particularly in patients aged 40 years and younger. As such, SUDEP may share mechanisms similar to sudden infant death syndrome.
Jennifer Liebenthal - One of the best experts on this subject based on the ideXlab platform.
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association of Prone Position with sudden unexpected death in epilepsyauthor response
Neurology, 2015Co-Authors: Nitin K Sethi, Jennifer Liebenthal, Shasha Wu, Sandra Rose, Samden D Lhatoo, Lina Nashef, Torbjorn Tomson, Philippe Ryvlin, John S EbersoleAbstract:Editors' Note: “Association of Prone Position with sudden unexpected death in epilepsy” raised several inquiries from our readers. Sethi suggests that since the pathogenesis of sudden unexpected death in epilepsy (SUDEP) is not yet elucidated, advising patients to sleep in the supine Position, which risks aspiration, warrants careful consideration. Furthermore, based on their prior study, Lhatoo et al. believe that forced ictal version, rather than Prone Position, may be a SUDEP risk factor. Authors Tao et al. argue that supine sleeping can help prevent SUDEP and, although it could be associated with aspiration, babies seizing face-down risk suffocation. —Chafic Karam, MD, and Robert C. Griggs, MD Liebenthal et al.1 studied the association of Prone Position with sudden unexpected death in epilepsy (SUDEP). The central dogma underlying SUDEP is unclear. Does postictal cerebral shutdown represented by postictal generalized EEG suppression (PGES) cause hypoxemia, hypercapnia, pulmonary edema, and autonomic instability, resulting in death? It is also possible that the primary peri-ictal involvement of brainstem neurons (pre-Botzinger complex) sets off the cascade that manifests as PGES at the end of a terminal seizure. …
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association of Prone Position with sudden unexpected death in epilepsy
Neurology, 2015Co-Authors: Jennifer Liebenthal, Shasha Wu, Sandra Rose, John S EbersoleAbstract:Objective: To examine the association between Prone Position and sudden unexpected death in epilepsy (SUDEP). Methods: We conducted a systematic review and meta-analysis based on a literature search from databases PubMed, Web of Science, and Scopus, using keywords “SUDEP” or “sudden unexpected death in epilepsy” or “sudden unexplained death syndromes in epilepsy.” Twenty-five publications met the inclusion and exclusion criteria and were enrolled in this study. Results: Body Positions were documented in 253 cases of SUDEP. Of these patients, 73.3% (95% confidence interval [CI] = 65.7%, 80.9%) died in the Prone Position, whereas 26.7% (95% CI = 16.3%, 37.1%) died in nonProne Positions. Binary random-effects analysis showed that Prone Position is significantly associated with SUDEP, as compared with nonProne Position ( p p = 0.009). Conclusion: There is a significant association between Prone Position and SUDEP, which suggests that Prone Position is a major risk factor for SUDEP, particularly in patients aged 40 years and younger. As such, SUDEP may share mechanisms similar to sudden infant death syndrome.
M. Mure - One of the best experts on this subject based on the ideXlab platform.
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oxygenation and cerebral perfusion pressure improved in the Prone Position
Acta Anaesthesiologica Scandinavica, 2006Co-Authors: Michael Nekludov, B M Bellander, M. MureAbstract:Background: Treatment of patients in the Prone Position is a well-established method to improve oxygenation in general intensive care unit (ICU) practice. This method is rarely used in a neurosurgical ICU, considering the risk of intracranial hypertension. The aim of this study was to analyse the effect of Prone Position on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and systemic oxygenation in patients with reduced intracranial compliance. We hypothesize that the beneficial effects of Prone Position can outweigh the hazardous effects on the intracranial pressure. Methods: Eight patients with traumatic brain injury or subarachnoid hemorrhage (SAH) were studied in the supine and Prone posture. Hemodynamics, arterial oxygenation, respiratory mechanics, ICP and CPP were continuously measured. Results: A significant improvement in PaO2 was observed in the Prone Position, from 12.6 ± 1.4 kPa to 15.7 ± 3.2 kPa (P= 0.02). Both intracranial pressure and mean arterial pressure increased in the Prone Position, from 12 ± 6 to 15 ± 4 mmHg (P= 0.03) and from 78 ± 8 to 88 ± 8 mmHg (P= 0.005), respectively. Arterial pressure increased to a greater extent than ICP, resulting in improved CPP, from 66 ± 7 to 73 ± 8 mmHg (P= 0.03) in the Prone Position. Conclusions: The Prone Position can be used to improve the oxygenation as well as CPP in patients with traumatic brain injury or SAH. However, this method results in raised ICP, and should be used cautiously in patients with reduced intracranial compliance.
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Prone Position improves gas exchange--but how?
Acta Anaesthesiologica Scandinavica, 2001Co-Authors: M. Mure, S. G. E. LindahlAbstract:Abstract * Mechanically ventilated patients with severe acute lung insufficiencies dramatically improve their gas exchange when treated in the Prone Position. * ventilation heterogeneity is greater in the supine then in the Prone Position during CMV. * the dominant dorsal Q while supine is not turned into a dominant ventral Q in the Prone Position. * in the presence of an abdominal distension, the Prone Position more clearly improves gas exchange than at normal abdominal pressures. * CPAP enhances the dominant dorsal lung perfusion while supine. In the Prone Position lung perfusion is more uniform. * V/Q matching is improved in the Prone Position during CMV.
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regional ventilation perfusion distribution is more uniform in the Prone Position
Journal of Applied Physiology, 2000Co-Authors: M. Mure, Michael P Hlastala, Karen B. Domino, Sten G E Lindahl, William A Altemeier, Robb W GlennyAbstract:The arterial blood P O 2 is increased in the Prone Position in animals and humans because of an improvement in ventilation (V˙a) and perfusion (Q˙) matching. However, the mechanism of improvedV˙a/Q...
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Pulmonary gas exchange improves in the Prone Position with abdominal distension.
American journal of respiratory and critical care medicine, 1998Co-Authors: M. Mure, Robb W Glenny, Karen B. Domino, Michael P HlastalaAbstract:Arterial blood oxygenation in patients with adult respiratory distress syndrome is often improved in the Prone Position. Critically ill patients often have abdominal distension and whether similar improvements in gas exchange occur with the Prone Position is not known. We therefore studied the effect of posture on gas exchange in eight ketamine-anesthetized pigs with abdominal distension. A rubber balloon, placed in the abdominal cavity, was filled with water to increase intra-abdominal pressure. The animals were mechanically ventilated with FIO2 = 0.4, and PaCO2 was kept constant. Gas exchange was measured in the supine and Prone Positions, with and without abdominal distension, in random order, using the multiple inert gas elimination technique (MIGET). When the abdomen was normal, the Prone Position increased PaO2 by 16 +/- 21 mm Hg (p < 0.05), accompanied by a small, but statistically insignificant, decrease in AaPO2 (p = 0.08) and no change in ventilation/perfusion (V A/Q) heterogeneity measured by MIGET. In the presence of abdominal distension, the Prone Position increased Pa O2 by 26 +/- 18 mm Hg (p < 0.01) and decreased AaPO2 (p < 0.05) and V A/Q heterogeneity as measured by the log standard deviation of the perfusion distribution (p < 0.01) and the arterial-alveolar difference area (p < 0.05). In addition, intragastric pressure was lower in the Prone Position (p < 0.01). We conclude that in anesthetized, mechanically ventilated pigs, the Prone Position improves pulmonary gas exchange to a greater degree in the presence of abdominal distension than when the abdomen is normal.
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pulmonary gas exchange improves in the Prone Position with abdominal distension
American Journal of Respiratory and Critical Care Medicine, 1998Co-Authors: M. Mure, Robb W Glenny, Karen B. Domino, Michael P HlastalaAbstract:Arterial blood oxygenation in patients with adult respiratory distress syndrome is often improved in the Prone Position. Critically ill patients often have abdominal distension and whether similar improvements in gas exchange occur with the Prone Position is not known. We therefore studied the effect of posture on gas exchange in eight ketamine-anesthetized pigs with abdominal distension. A rubber balloon, placed in the abdominal cavity, was filled with water to increase intra-abdominal pressure. The animals were mechanically ventilated with Fi O2 = 0.4, and PaCO2 was kept constant. Gas exchange was measured in the supine and Prone Positions, with and without abdominal distension, in random order, using the multiple inert gas elimination technique (MIGET). When the abdomen was normal, the Prone Position increased PaO2 by 16 ± 21 mm Hg (p < 0.05), accompanied by a small, but statistically insignificant, decrease in aaPo 2 (p = 0.08) and no change in ventilation/perfusion (V˙ a/Q˙) heterogeneity measured by...
Shasha Wu - One of the best experts on this subject based on the ideXlab platform.
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association of Prone Position with sudden unexpected death in epilepsyauthor response
Neurology, 2015Co-Authors: Nitin K Sethi, Jennifer Liebenthal, Shasha Wu, Sandra Rose, Samden D Lhatoo, Lina Nashef, Torbjorn Tomson, Philippe Ryvlin, John S EbersoleAbstract:Editors' Note: “Association of Prone Position with sudden unexpected death in epilepsy” raised several inquiries from our readers. Sethi suggests that since the pathogenesis of sudden unexpected death in epilepsy (SUDEP) is not yet elucidated, advising patients to sleep in the supine Position, which risks aspiration, warrants careful consideration. Furthermore, based on their prior study, Lhatoo et al. believe that forced ictal version, rather than Prone Position, may be a SUDEP risk factor. Authors Tao et al. argue that supine sleeping can help prevent SUDEP and, although it could be associated with aspiration, babies seizing face-down risk suffocation. —Chafic Karam, MD, and Robert C. Griggs, MD Liebenthal et al.1 studied the association of Prone Position with sudden unexpected death in epilepsy (SUDEP). The central dogma underlying SUDEP is unclear. Does postictal cerebral shutdown represented by postictal generalized EEG suppression (PGES) cause hypoxemia, hypercapnia, pulmonary edema, and autonomic instability, resulting in death? It is also possible that the primary peri-ictal involvement of brainstem neurons (pre-Botzinger complex) sets off the cascade that manifests as PGES at the end of a terminal seizure. …
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association of Prone Position with sudden unexpected death in epilepsy
Neurology, 2015Co-Authors: Jennifer Liebenthal, Shasha Wu, Sandra Rose, John S EbersoleAbstract:Objective: To examine the association between Prone Position and sudden unexpected death in epilepsy (SUDEP). Methods: We conducted a systematic review and meta-analysis based on a literature search from databases PubMed, Web of Science, and Scopus, using keywords “SUDEP” or “sudden unexpected death in epilepsy” or “sudden unexplained death syndromes in epilepsy.” Twenty-five publications met the inclusion and exclusion criteria and were enrolled in this study. Results: Body Positions were documented in 253 cases of SUDEP. Of these patients, 73.3% (95% confidence interval [CI] = 65.7%, 80.9%) died in the Prone Position, whereas 26.7% (95% CI = 16.3%, 37.1%) died in nonProne Positions. Binary random-effects analysis showed that Prone Position is significantly associated with SUDEP, as compared with nonProne Position ( p p = 0.009). Conclusion: There is a significant association between Prone Position and SUDEP, which suggests that Prone Position is a major risk factor for SUDEP, particularly in patients aged 40 years and younger. As such, SUDEP may share mechanisms similar to sudden infant death syndrome.
Sandra Rose - One of the best experts on this subject based on the ideXlab platform.
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association of Prone Position with sudden unexpected death in epilepsyauthor response
Neurology, 2015Co-Authors: Nitin K Sethi, Jennifer Liebenthal, Shasha Wu, Sandra Rose, Samden D Lhatoo, Lina Nashef, Torbjorn Tomson, Philippe Ryvlin, John S EbersoleAbstract:Editors' Note: “Association of Prone Position with sudden unexpected death in epilepsy” raised several inquiries from our readers. Sethi suggests that since the pathogenesis of sudden unexpected death in epilepsy (SUDEP) is not yet elucidated, advising patients to sleep in the supine Position, which risks aspiration, warrants careful consideration. Furthermore, based on their prior study, Lhatoo et al. believe that forced ictal version, rather than Prone Position, may be a SUDEP risk factor. Authors Tao et al. argue that supine sleeping can help prevent SUDEP and, although it could be associated with aspiration, babies seizing face-down risk suffocation. —Chafic Karam, MD, and Robert C. Griggs, MD Liebenthal et al.1 studied the association of Prone Position with sudden unexpected death in epilepsy (SUDEP). The central dogma underlying SUDEP is unclear. Does postictal cerebral shutdown represented by postictal generalized EEG suppression (PGES) cause hypoxemia, hypercapnia, pulmonary edema, and autonomic instability, resulting in death? It is also possible that the primary peri-ictal involvement of brainstem neurons (pre-Botzinger complex) sets off the cascade that manifests as PGES at the end of a terminal seizure. …
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association of Prone Position with sudden unexpected death in epilepsy
Neurology, 2015Co-Authors: Jennifer Liebenthal, Shasha Wu, Sandra Rose, John S EbersoleAbstract:Objective: To examine the association between Prone Position and sudden unexpected death in epilepsy (SUDEP). Methods: We conducted a systematic review and meta-analysis based on a literature search from databases PubMed, Web of Science, and Scopus, using keywords “SUDEP” or “sudden unexpected death in epilepsy” or “sudden unexplained death syndromes in epilepsy.” Twenty-five publications met the inclusion and exclusion criteria and were enrolled in this study. Results: Body Positions were documented in 253 cases of SUDEP. Of these patients, 73.3% (95% confidence interval [CI] = 65.7%, 80.9%) died in the Prone Position, whereas 26.7% (95% CI = 16.3%, 37.1%) died in nonProne Positions. Binary random-effects analysis showed that Prone Position is significantly associated with SUDEP, as compared with nonProne Position ( p p = 0.009). Conclusion: There is a significant association between Prone Position and SUDEP, which suggests that Prone Position is a major risk factor for SUDEP, particularly in patients aged 40 years and younger. As such, SUDEP may share mechanisms similar to sudden infant death syndrome.
