Tredelenburg Position and Hypotension
Abstract
Hypotension is one of the top three most frequent causes of cardiac arrests in the United States. One early intervention used in treating hypotension is placing patients in Trendelenburg position. The purpose of this research was to review information on the use of the Trendelenburg position or variations of it to determine whether this position has an impact on hemodynamic status, to describe historical practices of the Trendelenburg position, state the reasons and need for possible change, described current best evidence, and define pros and cons for making the practice changes. Research material included scholarly peered articles, Internet Resources, and nursing textbooks revealing many studies which question the benefit of the Trendelenburg position. Research also showed great diversity of therapeutic indications. Current evidence is too inconsistent to allow us to state that the Trendelenburg position is beneficial in hemodynamically compromised patients. Key words: Head-down tilt. Shock. Patient positioning. Trendelenburg. Hypotension.
Fig. 1 Fig. 2
In the late 19th century, Friedrich Trendelenburg (1844-1924) (Fig. 2), a German urologic surgeon, popularized the use of a supine position, with the feet raised higher than the head to facilitate surgical access to the abdominal and pelvic viscera. This position was coined the Trendelenburg position which to this day still bears his name. Years later, during the First World War, the American physiologist Walter B. Cannon adopted this position to displace blood from the lower extremities to enhance venous return in the treatment of hemorrhagic hypovolemic shock. This action was thought to cause an “autotransfusion” to the central circulation, increasing right and left ventricular pre-loads, stroke volume, and cardiac output or cardiac index. Although Cannon changed his opinion on the benefits of the Trendelenburg position, a decade later, its use continued to spread.
Friedrich
Hypotension is one of the top three most frequent causes of cardiac arrests in the United States. One early intervention used in treating hypotension is placing patients in Trendelenburg position. The purpose of this research was to review information on the use of the Trendelenburg position or variations of it to determine whether this position has an impact on hemodynamic status, to describe historical practices of the Trendelenburg position, state the reasons and need for possible change, described current best evidence, and define pros and cons for making the practice changes. Research material included scholarly peered articles, Internet Resources, and nursing textbooks revealing many studies which question the benefit of the Trendelenburg position. Research also showed great diversity of therapeutic indications. Current evidence is too inconsistent to allow us to state that the Trendelenburg position is beneficial in hemodynamically compromised patients. Key words: Head-down tilt. Shock. Patient positioning. Trendelenburg. Hypotension.
Fig. 1 Fig. 2
In the late 19th century, Friedrich Trendelenburg (1844-1924) (Fig. 2), a German urologic surgeon, popularized the use of a supine position, with the feet raised higher than the head to facilitate surgical access to the abdominal and pelvic viscera. This position was coined the Trendelenburg position which to this day still bears his name. Years later, during the First World War, the American physiologist Walter B. Cannon adopted this position to displace blood from the lower extremities to enhance venous return in the treatment of hemorrhagic hypovolemic shock. This action was thought to cause an “autotransfusion” to the central circulation, increasing right and left ventricular pre-loads, stroke volume, and cardiac output or cardiac index. Although Cannon changed his opinion on the benefits of the Trendelenburg position, a decade later, its use continued to spread.
Friedrich
Cited: Clark, A. & Shammas, A. (2008). Trendelenburg Positioning to Treat Acute Hypotension: Helpful or Harmful? Clinical Nurse Specialist Halm, M. (2012). Trendelenburg Position: “Put To Bed” or Angled Toward Use In Your Unit? American Journal of Critical Care Pena, S. & Larrad, A. (2012). Does the Trendelenburg Position Affect Hemodynamics? A Systemic Review Sheppard, R. Personal Communications, June 28, 2013. Wilcox, S. & Vandam, L. (2008). Alas, Poor Trendelenburg and His Position! A Critique of Its Uses and Effectiveness