Trendelenburg Position

The Trendelenburg position was originally used to improve surgical exposure of the pelvic organs.
It's credited to German surgeon Friedrich Trendelenburg (1844-1924). After World War I, use of
the Trendelenburg position became common practice in managing patients with shock. The
position was later used to prevent air embolism during central venous cannulation and to enhance
the effects of spinal anesthesia.
In World War I, Walter Cannon, an American physiologist, popularized the use of the
Trendelenburg position as a treatment for shock. The Trendelenburg position involves the patient
being placed with their head down and feet elevated. This position was promoted as a way to
increase venous return to the heart, increase cardiac output and improve vital organ perfusion. A
decade later, Cannon reversed his opinion regarding the use of the Trendelenburg position, but this
didn't deter its widespread use. The Trendelenburg position is still a pervasive treatment for shock
despite numerous studies failing to show effectiveness.

The authors of this study replicated what another study did in 2005. They did this by searching the
literature for published research on the value of the Trendelenburg position. They found 30 articles,
of which only nine were peer reviewed. The common theme in all the studies was that, in both
normotensive and hypotensive patients, the Trendelenburg increased venous pressures but didn't
result in significant improvement in systolic blood pressure. Patients with cardiogenic shock
experienced worsening pulmonary edema.
Some have suggested using a modified Trendelenburg position where the patient is kept flat and
the legs are raised above the heart. It has been suggested that this "auto-transfuses" the patient with
blood. However, the research doesn't support this. The volume of blood that drains from the lower
extremities in the hypovolemic patient is minimal and does not result in any significant rise in
blood pressure.
Considering that aspiration is a greater risk with the patient in the Trendelenburg position and the
lack of research supporting its use, perhaps it's time to consider other options. One exciting
prospect is an impedance threshold device for spontaneously breathing patients made by the
creators of the Res-Q-Pod. Perhaps we can begin to treat our patients based more on science than
on 150-year-old ritualized procedures.
Source : https://www.jems.com/articles/2009/04/myth-trendelenburg-position.html
Trendelenburg position untuk syok anafilaktik

Sambil melakukan hal ini, pasien dengan cepat diposisikan dalam posisi trendelenburg atau
berbaring dengan kedua tungkai diangkat (diganjal dengan kursi) karena akan membantu
menaikkan venous returnsehingga tekanan darah ikut meningkat.