Trendelenburg Position

[Kitiger, RN]

We have been using the Trendelenburg position (Head down ~ 15 degrees) for a 20 minute jiggle-vest treatment, to help mobilize lung secretions. While the jiggle-vest treatments are QID following nebulized Albuterol/Atrovent, the Trendelenburg position is used only once or twice daily.

I'm reading now that this position is not as helpful as once thought. Still, it does seem to help clear out the lungs. Is there any reason why this position should not be used for someone with pulmonary congestion? 

https://aacnjournals.org/ajcconline/article-abstract/6/3/172/6246/Use-of-the-Trendelenburg-position-by-critical-care?redirectedFrom=fulltext

[MunoRN, RN]

I would think the main consideration when used along with percussion/vibration would be the increased risk of aspiration in Trendelenburg.  For someone with an impaired pulmonary status, aspiration pneumonia isn't going to help their situation.

[Kitiger, RN]

Just now, MunoRN said:

I would think the main consideration would be the increased risk of aspiration in Trendelenburg.  For someone with an impaired pulmonary status, aspiration pneumonia isn't going to help their situation.

I agree, but this is done just before a meal, when, ideally, the stomach is mostly empty.

Would you still be concerned about aspiration pneumonia?

[Guest219794]

Trendelenburg for hypotension is often used as an example of a persistent nursing myth.  It was considered state of the art in the late 1800's, and has had no evidence to base its practice since then.

But- that does not mean that this position not have other beneficial uses.  For example- if looking for an EJ.  And, apparently maybe for treating covid.

Like anything else, there are costs and benefits.  If pulmonologists are using it, they are well aware of the downsides.  

[Kitiger, RN]

On 11/27/2021 at 11:28 PM, hherrn said:

Trendelenburg for hypotension is often used as an example of a persistent nursing myth.  It was considered state of the art in the late 1800's, and has had no evidence to base its practice since then.

But- that does not mean that this position not have other beneficial uses.  For example- if looking for an EJ.  And, apparently maybe for treating covid.

Like anything else, there are costs and benefits.  If pulmonologists are using it, they are well aware of the downsides.  

What is an "EJ"?

[chare]

1 hour ago, Kitiger said:

What is an "EJ"?

External jugular.

[Guest219794]

The position causes certain physiologic changes- like making an external jugular engorge.  It just doesn't do what people, for years, (some currently) thought it did, which as to increase perfusion of critical organs.

Interesting that it can be used to treat respiratory problems, as one of the known risks is to the respiratory system.  You will neversee a person in respiratory put them selves into Trendelenburg to make it easier to breath.

But, apparently when it comes to mobilizing secretions, gravity is a powerful tool.  Any links to any literature on the process?

[Kitiger, RN]

15 hours ago, hherrn said:

The position causes certain physiologic changes- like making an external jugular engorge.  It just doesn't do what people, for years, (some currently) thought it did, which as to increase perfusion of critical organs.

Interesting that it can be used to treat respiratory problems, as one of the known risks is to the respiratory system.  You will never see a person in respiratory put themselves into Trendelenburg to make it easier to breath.

But, apparently when it comes to mobilizing secretions, gravity is a powerful tool.  Any links to any literature on the process?

Thank you all for your input.

In my experience, we do get more coughed out after doing percussion with the head down ~ 15 degrees. Also, the SpO2 tends to go up with this . . . in this client, at least. However, I have been unable to find much literature, and none that is specifically about mobilizing secretions. This is why I'm asking about it here.