Trendelenburg Position and Passive Leg Raising Do Not Significantly Improve Cardiopulmonary Performance in the Anesthetized Patient with Coronary Artery Disease

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“…34,35 This shift increases aortic volume, may not activate baroreceptors, and avoids risk of gastric aspiration. In one study, 25 researchers reported the same adverse cardiovascular and pulmonary effects for passive leg raising as for Trendelenburg positioning in 18 cardiac surgery patients. Others have shown that this maneuver correlates with the response to fluid loading and is predictive of the need for fluid when a patient's cardiac output, stroke volume variation, or blood pressure respond positively to the leg lift maneuver.…”

“…[21][22][23] Even in elderly normotensive patients, who may have some degree of impairment of vasomotor control owing to their age, no deterioration was noted in cardiac hemodynamic parameters with use of the Trendelenburg position. 24 Hypotensive patients appear to have different and more varied cardiovascular responses to the headdown position, 21,25 and they show no improvement in blood pressure or cardiac index. [18][19][20][21][24][25][26] As well, key components of tissue oxygenation are not improved with the Trendelenburg position.…”

“…24 Hypotensive patients appear to have different and more varied cardiovascular responses to the headdown position, 21,25 and they show no improvement in blood pressure or cardiac index. [18][19][20][21][24][25][26] As well, key components of tissue oxygenation are not improved with the Trendelenburg position. 27 Most investigators have concluded that use of the Trendelenburg position in hypotensive patients has no cardiovascular benefit.…”

“…27 Most investigators have concluded that use of the Trendelenburg position in hypotensive patients has no cardiovascular benefit. [18][19][20][21][24][25][26] Hewer, 17 in his 1956 review of complications of the Trendelenburg position, discussed the untoward effects on lung ventilatory mechanics and pulmonary gas exchange. These effects included reduced vital capacity even at 20º head-down tilt, increased work of breathing, and impaired respiration causing hypercarbia and hypoxemia.…”

“…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.…”