Medication of Diseases News - Part 8

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Trifurcation pattern

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Trifurcation patternIn the present study, we used selected lungs in which identification of the segmental bronchi was clear and easy, such as a right upper bronchus with a simple trifurcation pattern. Does this impose a critical limitation on the study or introduce a selection bias to the results? Simple trifurcation of B, B2, and B occurs in only 30% or 40% of Japanese subjects. Conversely, three major variations, B1 + 2, B1 + 3, and B2 + 3, are observed in almost half of right lungs. However, these major variations do not seem to compromise segment-specific drainage in a specific posture because their common trunks are usually very short. We speculate that problems may arise in < 10% of lungs in which one of the subsegmental bronchi (eg, B2a) forms a common trunk with another segmental bronchus (eg, B).

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Tracheal intubation

According to our anatomic results, we predict effectiveness of the following sequence of postures: supine, 45° rotative prone with left side up, 45° rotative prone with right side up, and return to supine (Fig 1, right, G through I) for simple, safe, and convenient bronchial drainage, especially for patients with tracheal intubation. However, our recommendations are not without potential disadvantages, and these are outlined in Table 4. For the two subsegmental bronchi of Ba, effective drainage is not likely to be achieved with a single posture, but will require a combination of the supine (for Bb) and 45° rotative prone (for Ba) positions. Because patients are usually cared for in the supine position, bronchial secretions from Ba may often (almost 50% of right lungs, data not shown) move easily to Bb. However, in the next turn in the present sequence, moving into the 45° rotative prone with left-side-up position would remove these accumulated secretions from Bb. Likewise, in almost half of the lungs, discharge from Bb seems to move to Ba in the rotative prone position. This would be removed in the next turn to supine. http://naturalbreastenhancementpill.com/

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: The classical recommendations

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: The classical recommendationsNotably, the present work revealed that the 45° rotative prone position was often more effective than the classical recommendations. Although we concentrated on S-S, S1 + 2, and S, the classical method seemed less effective in draining the middle and lower lobes (ie, using the simple prone position for B and B), but the 45° rotative prone position appeared much more effective. Moving a patient into the prone position requires two or three people, including a physiotherapist, whereas one person alone can move a patient into the 45° rotative prone position. Although there may be no pathologic condition prohibiting use of the prone position, the choice of this posture, rather than the 45° rotative prone position, may have resulted simply from an anatomic misunderstanding.

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Discussion

Likewise, the small 0 angle for B in the prone position (Figs 4, bottom right, D, and 5, bottom, C) mainly affected that for Bb (Table 4). We found that the 45° rotative prone position with left or right side up was effective in improving this difficult drainage from Ba, B2b, and Bb in the right lung and Ba-c in the left lung, although this posture is not included in the recommended sequences. Especially in the right Bb and in the left Bb and Bc, a positive shift in the distributions of individual 0 angles was evident (data not shown) when the posture was changed from prone to 45° rotative prone. For the two subsegmental bronchi of B, effective drainage could not be achieved with a single posture but needed a combination of the supine (for Bb) and 45° rotative prone (for Ba) positions.

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Subsegmental Bronchi

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Subsegmental BronchiRunning Directions of the Subsegmental Bronchi and Recommended Postures for Draining the Segment
Is the posture traditionally recommended for each segment (Fig 1) really effective in draining its peripheral or subsegmental levels? Table 4 shows the incidences of recurrent courses or negative 0 angles (causing extreme difficulty in drainage) and of positive but small 0 angles (< 20°, causing relative difficulty in drainage) for each of the subsegmental bronchi. The direction in which a subsegmental bronchus ran when the lung was placed in the recommended posture for draining a particular segment depended not only on the 0 angle of the mother segmental bronchus (0s in Fig 2; see first subsection in “Results”), but also on the branching angle at the origin of the subsegmental bronchus (see second subsection in “Results”).

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Segmental Bronchus

For the left lung, we found a clear difference in the effectiveness of B1 + 2 drainage between two similar recommended postures: the 45° rotative prone position with or without the head raised (Fig 5, top, A). With the head raised, the craniocaudal axis of the lung was tilted at 30°, thus providing a great increase in the 0 angle. This angle ranged from 35.0 to 85.0° (mean, 57.8 ± 11.6°) for B1 + 2 in the 45° rotative prone with head-raised position; in the simple 45° rotative prone position, it ranged from 10.0 to 60.0° (mean, 36.2 ± 13.0°). For B and B in the right and left lungs, the recommended supine or prone positions often or usually (B, 17 of 52 lungs; B, 40 of 52 lungs) produced an acute angle of < 45° (Fig 5, center, B, and bottom, C). These inadequate angles were more frequently seen in the left lung than in the right lung, and were especially evident with the left B. However, as with the right lung (see above), we found that the 45° rotative prone position provided good B drainage in the left lung (Fig 5, bottom, C). The 0 angle ranged from 25.0 to 75.0° (mean, 49.9 ± 11.6°) for B in the supine position and from 5.0 to 70.0° (mean, 34.7 ± 11.3°) for B in the prone position. For the other left segmental bronchi (B, B, B, B, and B), large 0 angles were obtained with the same positions as in the right lung. Consequently, instead of the recommended postures, the supine position would be most effective in draining B and B, and the 45° rotative prone (left-side-up) position would be most effective in draining B and B.

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Lungs

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: LungsAlthough either bending forward or the 45° rotative prone position is recommended for B2 drainage, elevation of B2 by > 45° from the horizontal was more often observed in the latter position (47 of 54 lungs; Fig 4, top right, B) than in the former. The 0 angle for B2 ranged from 15.0 to 75.0° (mean, 42.5 ± 15.0°) when bending forward; in the 45° rotative prone position, it ranged from 20.0 to 85.0° (mean, 55.6. ± 14.4°).

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Horizontal course

In these lungs, B exhibited an almost horizontal course, for which we measured 0 angles of — 5° to — 10° from the horizontal in the supine position. Similarly, B2 ran in a dorsal direction (0 angle in the supine position, — 65.9 ± 15.9°) but never took a true dorsal course (maximum angle, — 85° from the horizontal). However, a 0 angle of < — 60° was found for the B2 of 39 right lungs in the supine position. In both the left and right lungs, the B2 courses tended to shift dorsally more frequently than those of B. B formed an mean angle of 16.7 ± 10.1° from the horizontal in the supine position, while B1 + 2 formed an angle of — 8.8 ± 13.0°. These small 0 angles meant that both segmental bronchi ran almost horizontally. Completely horizontal courses were recorded for the B of two right lungs and the B1 + 2 of seven left lungs. However, B almost always followed a ventral course with a positive 0 angle in the right lung (52 of the 54 specimens), whereas in most of the left lungs (40 of the 52 specimens), B1 + 2 displayed a dorsal course with a negative 0 angle. buy paxil online

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Results

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: ResultsThe upper lobar bronchi and those in S were measured in all specimens, while the bronchi in other segments were examined in approximately 10 specimens from either side. According to the data obtained for the supine position (Fig 3), the running direction and 0 angle were calculated for each postural variation (Fig 1). A “head-raised” posture was estimated to correspond to an additional 30° elevation from the basic posture. During the dissections and measurements, we were careful to maintain the natural topographic relationships between the bronchi, and between the bronchi and the costal surface of the lung, so as to reproduce the original bronchial anatomy of each cadaver.

Anatomic Evaluation of Postural Bronchial Drainage of the Lung With Special Reference to Patients With Tracheal Intubation: Materials and Methods

Consequently, we aimed to investigate whether the running directions of the subsegmental bronchi allow effective drainage when a patient is placed in the recommended postures. In a preliminary study, we concentrated on dissections of S, S2, S, and S in the right lung, and S1 + 2, S, and S in the left lung because, in these segments, we sometimes found that the subsegmental bronchi followed an almost horizontal course when the body was in the recommended postures (Fig 3). We knew that anatomic evidence does not always connect to a good clinical result. But we wished to postulate an anatomically based sequence of postural bronchial drainage positions, especially for patients with tracheal intubation, because the usual method (see earlier) includes the prone position, which is sometimes very difficult to achieve. add comment

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