Head down position: hypoxemia

Generic Clinical Sciences

Respiratory Effects

b. Increased work of breathing secondary to increased impedance to stretching of chest wall and diaphragm

Why is head down BAD in cases of hypotension?

When trendelenberg position is used with the hopes of raising a pt’s blood pressure, INITIALLY central blood volume increases by 1L in the adult patient and this will cause reflex barostimulation and then systemic vasodilation, which will then lead to decreased CO, SV and therefore DECREASED perfusion to BRAIN. Current literature has shown in many studies( Johansson, Sing ) HEAD DOWN position (ie Trendelenburg) will cause increases MAP (mean arterial pressure), PCW (pulmonary capillary wedge pressure), SVR (systemic vascular resistance). Furthermore, there was NO CHANGE in OXYGEN DELIVERY , CI, O2 consumption.

HEAD DOWN IS NO LONG RECOMMENDED AS THERAPY FOR HYPOVOLEMIC SHOCK

HOWEVER LAWN CHAIR IS BETTER for shock because 1. it elevates HEAD: minimizes cerebral congestion, IMPROVES cerebral oxygenation and 2. it elevates LEGS: increases VENOUS return, augments CO. 

Physiologic Effects of Head-Down Positioning

  • Cardiac: initial fluid bolus (1L) , quickly offset by reflex barostimulation, vasodilation, and potentially decreased perfusion of the brain
  • Respiratory: increased atelectasis, work of breathing, movement of ETT

Sources

    Crit Care Med;1979 May;7(5):218-24

    [PubMed: 467083]

    South Med J;1988 Oct;81(10):1258-60

    [PubMed: 3140385]

    Ann Emerg Med;1994 Mar;23(3):564-7

    [PubMed: 8135435]

41%

Answered correctly

2009

Year asked