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Trendelenburg position

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In the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. This is a standard position used in abdominal and gynecological surgery. It allows better access to the pelvic organs as gravity pulls the intestines away from the pelvis. It was named after the German surgeon Friedrich Trendelenburg.[1] It is not recommended for the treatment of hypovolaemic shock.[2]

Uses

  • Hypotensive patients (patients with low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure in the brain). A 2005 literature review found the "Literature on the position was scarce, lacked strength, and seemed to be guided by 'expert opinion.'"[3] A 2008 meta-analysis found adverse consequences to the use of the Trendelenburg position and recommended it be avoided.[4] However, the passive leg raising test is a useful clinical guide to fluid resuscitation and can be used for effective autotransfusion.[5]
  • The Trendelenburg position used to be the standard first aid position for shock.[6]
  • The Trendelenburg position was used for injured scuba divers.[7] Many experienced divers still believe this position is appropriate, but current scuba first aid professionals no longer advocate elevating the feet higher than the head. The Trendelenburg position in this case increases regurgitation and airway problems, causes the brain to swell, increases breathing difficulty, and has not been proven to be of any value.[8] "Supine is fine" is a good, general rule for victims of submersion injuries unless they have fluid in the airway or are breathing, in which case they should be positioned on the side.
  • Perhaps because of its effect on breathing difficulty and airway problems, the Trendelenburg position is used in waterboarding.
  • The Trendelenburg position may be used in childbirth when a woman's cervix is too swollen and won't quite dilate to 10 centimeters, or during the incidence of a prolapsed umbilical cord to take pressure off the cord and get more oxygen to the fetus, or it can be used to help rotate a posterior fetus either during pregnancy or the birth itself.
  • Trendelenburg position is helpful in surgical reduction of an abdominal hernia.[9]
  • The Trendelenburg position is also used when placing a Central Venous Line.[10] Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins when placing a central line in the internal jugular or subclavian veins. It is also used in the placement of an external jugular peripheral line for the same reason. It plays no role in the placement of a femoral central venous line.

See also

References

  1. ^ Enersen, Ole Daniel. "Trendelenburg's position". Whonamedit.com. Retrieved 2009-03-04.
  2. ^ Emerg Med J 2010;27:877-878 doi:10.1136/emj.2010.104893 http://emj.bmj.com.cyber.usask.ca/content/27/11/877.extract
  3. ^ Bridges N, Jarquin-Valdivia AA (2005). "Use of the Trendelenburg position as the resuscitation position: to T or not to T?". Am. J. Crit. Care. 14 (5): 364–8. PMID 16120887. Retrieved 2009-03-19. {{cite journal}}: Unknown parameter |month= ignored (help)
  4. ^ "BestBets: Use of the Trendelenburg Position to Improve Hemodynamics During Hypovolemic Shock".
  5. ^ Terai C, Anada H, Matsushima S, Kawakami M, Okada Y (1996). "Effects of Trendelenburg versus passive leg raising: autotransfusion in humans". Intensive Care Med. 22 (6): 613–4. doi:10.1007/BF01708113. PMID 8814487. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Johnson S, Henderson SO (2004). "Myth: the Trendelenburg position improves circulation in cases of shock". CJEM. 6 (1): 48–9. PMID 17433146. Retrieved 2009-03-19. {{cite journal}}: Unknown parameter |month= ignored (help)
  7. ^ Stonier, JC (1985). "A study in prechamber treatment of cerebral air embolism patients by a first provider at Santa Catalina Island". Undersea Biomedical Research. 12 (1 supplement). Undersea and Hyperbaric Medical Society. Retrieved 2009-03-19.
  8. ^ Pulley, Stephen A. "eMedicine - Dysbarism". Retrieved 2008-03-15.
  9. ^ Buchwald H (1998). "Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese". Am. J. Surg. 175 (1): 63–4. doi:10.1016/S0002-9610(97)00233-X. PMID 9445243. Retrieved 2009-03-19. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ^ Amesur, Nikhil B. "eMedicine - Central Venous Access". Retrieved 2008-03-15.
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