Physiologic Mechanisms Associated with the Trendelenburg Position

Introduction: The Trendelenburg position is a common intervention used to stabilize patients in hemodynamic shock. It has been assumed that the head-down tilt position would create a hydrostatic gradient to improve venous return and, therefore, increase the cardiac output. However, numerous studies have shown this maneuver to be ineffective for hemodynamic enhancement. This study analyzed the physiologic mechanisms responsible for the limited benefits of Trendelenburg positioning.

[1]  V. Starc,et al.  The Effect of Trendelenburg Position, Lactated Ringer’s Solution and 6% Hydroxyethyl Starch Solution on Cardiac Output After Spinal Anesthesia , 2009, Anesthesia and analgesia.

[2]  A. Clark,et al.  Trendelenburg positioning to treat acute hypotension: helpful or harmful? , 2007, Clinical nurse specialist CNS.

[3]  Steven H Platts,et al.  Plasma volume restoration with salt tablets and water after bed rest prevents orthostatic hypotension and changes in supine hemodynamic and endocrine variables. , 2005, American journal of physiology. Heart and circulatory physiology.

[4]  A. Goetz,et al.  Trendelenburg positioning after cardiac surgery: effects on intrathoracic blood volume index and cardiac performance , 2003, European journal of anaesthesiology.

[5]  C. Ostrow Use of the Trendelenburg position by critical care nurses: Trendelenburg survey. , 1997, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[6]  L. Nuutinen,et al.  Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy , 1995, Acta anaesthesiologica Scandinavica.

[7]  Y. Okada,et al.  Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. , 1995, The American journal of emergency medicine.

[8]  C. Ostrow,et al.  The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study. , 1994, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[9]  P. L. Marino,,et al.  Trendelenburg position and oxygen transport in hypovolemic adults. , 1994, Annals of emergency medicine.

[10]  L. Doering,et al.  The effect of positioning on hemodynamics and gas exchange in the critically ill: a review. , 1993, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[11]  J. Spencer,et al.  Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy. , 1990, European journal of obstetrics, gynecology, and reproductive biology.

[12]  C. G. Blomqvist,et al.  Passive leg raising does not produce a significant or sustained autotransfusion effect. , 1982, The Journal of trauma.

[13]  W. Sibbald,et al.  The Trendelenburg Position: Hemodynamic Effects in Hypotensive and Normotensive Patients , 1980 .

[14]  W. Künzel [Vena cava occlusion syndrome. Cardiovascular parameters and uterine blood supply]. , 1976, Fortschritte der Medizin.

[15]  A C GUYTON,et al.  Relative importance of venous and arterial resistances in controlling venous return and cardiac output. , 1959, The American journal of physiology.

[16]  J. Satterfield,et al.  Dynamics of central venous resistance with observations on static blood pressure. , 1952, The American journal of physiology.

[17]  S. Henderson,et al.  Myth: the Trendelenburg position improves circulation in cases of shock. , 2004, CJEM.

[18]  N. Secher,et al.  Subcutaneous oxygen and carbon dioxide tensions during head-up tilt-induced central hypovolaemia in humans. , 1996, Scandinavian journal of clinical and laboratory investigation.