From the Guidelines
The Trendelenburg position is not recommended for routine use in critically ill patients due to potential haemodynamic side effects and increased risk of pressure ulcers, as suggested by the latest guidelines from 2024 1. When considering positioning in critically ill patients, it is essential to weigh the benefits and risks of each position. The Trendelenburg position, which involves tilting the patient in a supine position with their head lower than their pelvis, is not recommended for routine use. This is because it can lead to haemodynamic side effects, such as decreased cardiac output and increased intracranial pressure, as well as an increased risk of pressure ulcers 1. Instead, the guidelines recommend elevation of the upper body ≥ 40° in intubated patients, considering possible haemodynamic side effects and an increased risk of pressure ulcers 1. This position can help improve respiratory function and reduce the risk of complications. Some key points to consider when positioning critically ill patients include:
- Avoiding upper body elevation with flexion of the knees and hips in patients with elevated intraabdominal pressure or at its risk, and favouring the anti-Trendelenburg position for upper body elevation 1
- Performing a lateral position of about 90° with the healthy side down (good lung down) when ventilating patients with unilateral lung damage to improve gas exchange 1
- Regular modification of positioning to avoid the flat supine position as an inappropriate form of positioning 1
- Considering prone positioning in invasively ventilated patients with ARDS and impaired arterial oxygenation (PaO/FiO2 < 150 mmHg) 1 It is crucial to individualize patient care and consider the specific needs and risks of each patient when determining the best positioning strategy. By following the latest guidelines and considering the potential benefits and risks of each position, healthcare providers can optimize patient outcomes and reduce the risk of complications.
From the Research
Trendelenburg Position
- The Trendelenburg position is a medical technique where a patient is placed on a table or bed that's tilted so that their head is lower than their pelvis 2.
- This position is often used in medical procedures, such as surgery, to improve access to the pelvic area and to help with breathing in patients with respiratory problems 3.
- The Trendelenburg position can have both positive and negative effects on the body, including increased blood flow to the brain and lungs, but also potential complications such as respiratory and cardiovascular problems 4.
Medical Applications
- The Trendelenburg position is used in various medical applications, including: + Surgery: to improve access to the pelvic area and to reduce bleeding 3. + Respiratory distress: to help improve breathing in patients with respiratory problems, such as acute respiratory distress syndrome (ARDS) 2. + Hypovolemia: to help increase blood flow to the brain and lungs in patients with low blood volume 5.
- The position can be used as an alternative to other techniques, such as passive leg raising, to predict volume responsiveness in mechanically ventilated patients in the ICU 6.
Effects on the Body
- The Trendelenburg position can have various effects on the body, including: + Increased blood flow to the brain and lungs 5. + Increased cardiac output and mean arterial pressure 5. + Potential complications, such as respiratory and cardiovascular problems, visual field loss, and cognitive aberrations 4.
- The position can also affect lung compliance and diaphragmatic function, particularly in patients with ARDS 2.