Effects of trendelenburg and reverse trendelenburg postures on lung and chest wall mechanics

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…The reverse Trendelenburg position improves respiratory mechanisms and oxygenation, while the Trendelenburg position worsens lung compliance during PP (LE 3b) [396]. In a recent review, Valenza et al (LE 5) [392] reported that head-up positioning alone or PEEP in the supine position each has the same effect on lung volume and oxygenation, while P aw is lower when the patient is in the beach-chair position.…”

Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients

“…All of the patients were positioned with their neck in extension and head rotated left at [20][21][22][23][24][25][26][27][28][29][30] . Patients were studied in State 0, table flat (no tilt), with the patients in the supine position, and State T, in which the operating table was tilted 15 to a TP.…”

Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture

“…26 Ventilation and perfusion abnormalities, evidenced by an increase in intrapulmonary shunting, are also reported in the Trendelenburg position. 21 Not surprisingly, as body weight increases, lung resistance and gas exchange abnormalities also increase significantly, 28,29 which has important clinical implications for obese critically ill patients; thus the Trendelenburg position should be avoided in such patients.…”

“…In the Trendelenburg position, mechanical impedance of the lung and chest wall increases and is associated with increased resistance and decreased tidal volume. 28,29 Lung compliance can decrease by 20%, PaCO 2 increases, and a mild metabolic acidosis may develop. 26 Ventilation and perfusion abnormalities, evidenced by an increase in intrapulmonary shunting, are also reported in the Trendelenburg position.…”

“…Table 3 provides a summary of the evidence and physiological response to the Trendelenburg position. 17,21,24,25,[27][28][29][30][31][32] Alternatives to Trendelenburg positioning, such as passive leg lift, may provide greater benefit for initial management of hypotension or prediction of fluid responsiveness with minimal or no untoward effect. 34,35 Raising the patient's legs while keeping the head of the bed horizontal relative to the patient's trunk produces an approximate volume shift of 150 to 300 mL to the upper part of the thorax.…”