Trendelenburg positioning

[KBICU]

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?

[eCCU]

We do not put pts in trendelburg i think only OB and when inserting IJ in the ICU and i believe some surgeons use it during hernia surgeries. There is a meta analysis that was done in 2008 that actually stated that the position was in fact considered dangerous.....

[turnforthenurse, MSN, NP]

The position can raise ICP. I have only seen another nurse trendelenburg their patient during a rapid response once.

[focker14]

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!

[applewhitern, BSN, RN]

We stopped this practice years ago at my previous facility. Now I work at a hospital where I see this all the time, but it is mostly because the nurses here do things the way they were done 30 years ago.....

[sir.shocksalot]

I read a study where it was documented that trendelenburg caused no improvement in perfusion in settings of shock. Right now PHTLS and ITLS are both recommending that trendelenburg not be done at all. It sounds like it has gone the way of the MAST pants.

I will echo applewhitern and say that I still see it get done by those that really haven't kept up with the times.

[Nurserton]

Trendelenberging can cause the carotid baroreceptors in the neck to send signals to falsely drop blood pressure further by putting direct pressure on them and tricking them into believing the pressure is elevated. However, sometimes you just try anything and hope it works, especially if you are trying to refrain from putting the pt on pressors. Last time I tried it, true to science, it didn't raise their BP. However, if you have a neuro patient without ICP issues, it could be beneficial to make sure you're getting cerebral perfusion if you're gonna let the BP run low for whatever reason anyway.

[PMFB-RN, RN]

Trendelenberg for hypotension went away a long time ago and for good reason. I haven't seen it used, or used it in like 10 years. It went the way of bleeding patients to let out evil spirits.

[PMFB-RN, RN]

The appropiate position for shocky patients, like those coding or hypvolemic is the "shock position". That is flat on their back (unless contraindicated) with legs elivated.

[ckh23, BSN, RN]

The appropiate position for shocky patients, like those coding or hypvolemic is the "shock position". That is flat on their back (unless contraindicated) with legs elivated.

+1. This is what I do. All you need to do is elevated the legs, not put people on their heads. Each leg can hold 250-500 ml of blood each, so if they are hypo-volemic from hemorrhage or whatever, it will help.