Background: Acute hypotension has been treated with the Trendelenburg, or head down tilt (HDT), position for 100 years or more. Prior studies have suggested the HDT position increases central venous blood return and improves cardiac output, but the evidence is not consistent. This systematic review is designed to identify if there are known negative consequences of the HDT position on cardiopulmonary functioning, and determine if those risks outweigh the benefits.
Methods: An extensive search on Ovid Medline, CINAHL, and Evidence-Based Medicine Review Multifile was conducted to identify pertinent articles. The inclusionary criteria were, the use of HDT of greater than, or equal 10̊, and patients under general anesthesia.
Results: Six articles were identified and critically appraised. The data compiled in this systematic review suggest there is an increase in cardiac preload with no consequent increase in cardiac output or performance. The data suggest there are multiple negative consequences of HDT on pulmonary function including a decrease of functional residual capacity, an increase of atelectasis, and a decrease in oxygenation.
Conclusion: There is a lack of clear evidence to support the use of HDT as a treatment for acute hypotension. In the controlled environment of the surgical setting, head-down tilt should be utilized judiciously and for as short a duration as possible. HDT position should be avoided in patients who are obese, have pre-existing obstructive pulmonary disorders, have New York Heart Association class III heart failure, or other significant cardiopulmonary dysfunction
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