Trendelenburg position

Old depiction of the Trendelenburg position.

In the Trendelenburg position, the body is laid flat on the back (supine position) with the feet higher than the head by 15-30 degrees, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. Trendelenburg 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]

In the past, Trendelenburg position was used for patients in hypovolemic shock, with the thought that it would help maintain blood flow to the brain. This is no longer recommended because research shows it to be counterproductive.^[2]

Trendelenburg position In Surgery.

Current uses

• The Trendelenburg position is used to treat a surgical air embolism by placing the right ventricular outflow tract inferior to the right ventricular cavity, causing the air to migrate superiorly into a position within the right ventricle from which air is less likely to embolize. ^[3]
• The Trendelenburg position along with the Valsalva maneuver, termed as modified-Valsalva maneuver, is used for the cardioversion of ventricular tachycardia^[4]
• The Trendelenburg position is helpful in surgical reduction of an abdominal hernia.^[5]
• The Trendelenburg position is also used when placing a central venous line.^[6] The 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.
• The Trendelenburg position is also used in respiratory patients to create better perfusion.^[7]
• The Trendelenburg position has occasionally been used to produce symptomatic relief from septum posticum cysts of the subarachnoid space in the spinal cord, but does not bring about any long term benefits.^[8]
• The Trendelenburg position may be used for drainage images during endoscopic retrograde cholangiopancreatography. ^[9]

Obsolete uses

• People with hypotension (low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure to the brain). A 2005 review found the "Literature on the position was scarce, lacked strength, and seemed to be guided by 'expert opinion.'"^[10] A 2008 meta-analysis found adverse consequences to the use of the Trendelenburg position and recommended it be avoided.^[11] However, the passive leg raising test is a useful clinical guide to fluid resuscitation and can be used for effective autotransfusion.^[12]
• The Trendelenburg position used to be the standard first aid position for shock.^[13]
• The Trendelenburg position was used for injured scuba divers.^[14] 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.^[15] "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.

See also

• Trendelenburg gait
• Trendelenburg's sign
• Fowler's position
• High Fowlers position
• Recovery position
• Semi-Fowlers position
• Lift chair

References

1. Enersen, Ole Daniel. "Trendelenburg's position". Whonamedit.com. Retrieved 2009-03-04.
2. Kettaneh N (2010). "Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Use of the trendelenburg position to improve haemodynamics during hypovolaemic shock". Emergency Medicine Journal 27 (11): 877–8. doi:10.1136/emj.2010.104893. PMID 20972235.
3. Orebaugh SL (1992). "Venous air embolism: clinical and experimental considerations". Crit Care Med 20: 1169. PMID 1643897.
4. "Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial.". Lancet. doi:10.1016/S0140-6736(15)61485-4. PMID 26314489. Retrieved 21 January 2016.
5. Buchwald H (1998). "Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese". American Journal of Surgery 175 (1): 63–4. doi:10.1016/S0002-9610(97)00233-X. PMID 9445243.
6. Central Venous Access Imaging at eMedicine
7. Powers SK, Stewart MK, Landry G (1988). "Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion". Aviation, Space, and Environmental Medicine 59 (3): 239–45. PMID 3355478.
8. Teng P, Rudner N (1960). "Multiple arachnoid diverticula". Archives of Neurology 2: 348–56. doi:10.1001/archneur.1960.03840090112015. PMID 13837415.
9. Leung, Joseph. "Fundamentals of ERCP". In Cotton, Peter B. ERCP. GastroHep.
10. Bridges N, Jarquin-Valdivia AA (2005). "Use of the Trendelenburg position as the resuscitation position: to T or not to T?". American Journal of Critical Care 14 (5): 364–8. PMID 16120887.
11. Kettaneh, Nicolas (October 30, 2008). "Use of the Trendelenburg Position to Improve Hemodynamics During Hypovolemic Shock". BestBets.
12. Terai C, Anada H, Matsushima S, Kawakami M, Okada Y (1996). "Effects of Trendelenburg versus passive leg raising: autotransfusion in humans". Intensive Care Medicine 22 (6): 613–4. doi:10.1007/BF01708113. PMID 8814487.
13. Johnson S, Henderson SO (2004). "Myth: the Trendelenburg position improves circulation in cases of shock". CJEM 6 (1): 48–9. doi:10.1017/S1481803500008915. PMID 17433146.
14. Stonier, JC (1985). "A study in prechamber treatment of cerebral air embolism patients by a first provider at Santa Catalina Island". Undersea Biomedical Research (Undersea and Hyperbaric Medical Society) 12 (1 supplement). Retrieved 2009-03-19.
15. Dysbarism at eMedicine

External links

• Illustration of position in comparison to other positions
• Human Kinetics' Victim Positioning
• According to The Canadian Journal of Anesthesia