Just read an interesting article in the November AJCC that I thought I'd share with you guys. It researches the use of trendelenburg position and how it came to be common practice for an intervention for hypotension. It looks at the research and finds that it is more of just a tradition than an actually beneficial practice. I have been in numerous codes in my ICU and we've always trendelenburged the patient if it was warranted but now I am questioning that. What does everyone else think? It also says that if the patient is still conscious that it can lead to restlessness and the patient attempting to sit up (which I have seen too) which obviously isn't beneficial in code scenarios. What do you guys do?
That has been a debate for quite awhile. There are times when it is appropriate and times when it is not. If you need to buy yourself time until you can get a pressor started then by all means I would do it as long as it wasn't contraindicated such as increased ICP's, ARDS, etc...It is beneficial in practice when used appropriately. Doing open heart cases you can immediately seen an increase or decrease in BP and that is why it is used BUT it isn't used for more than a few minutes. I've sat there and argued with residents about NOT placing my patient in t-bird as the hypotension WAS NOT going to be fixed by just position alone! Your not "fixing" the problem just a temporary solution. Remember your body releases endogenous catecholamines in response to hypotension which is a good thing most of the time. Fooling your barorecptors into thinking everything is "ok" usually isn't the best option and regardless, the benefit of t-bird won't last but a few mintues anyways... Also as another poster mentioned T-bird is used A LOT in surgeries not just hernia repair though. Many laparoscopic cases utilize the position to get better views within the abdominal cavity....In robotic lap cases, sometimes our patients are in t-bird for over 6-7 hrs.....
jus my 5cents!
Last edit by focker14 on Nov 5, '12
: Reason: more to say