The Reverse Trendelenburg position is a common clinical modification where a patient lies on their back (supine) on an inclined surface, ensuring the head is positioned higher than the feet. This is the opposite of the standard Trendelenburg position, which places the head lower than the feet. This method leverages gravity for therapeutic and procedural benefits in medical and surgical settings.
Understanding the Position and How It Is Achieved
The position requires the patient to lie supine while the entire surface is tilted. The inclination typically ranges from 10 to 30 degrees, with the head end raised above the foot end. Specialized hospital beds or operating tables are used to achieve this uniform, flat-plane tilt.
These specialized tables articulate smoothly, lifting the entire body without bending the patient at the hips or knees. Since the patient is positioned on an incline, gravity pulls the body down toward the foot of the bed. To prevent sliding, safety mechanisms are employed.
Safety considerations include padded footboards or extenders anchored to the table to bear the patient’s weight. Adjustable straps or positioning aids may also be used across the chest or hips to ensure the patient remains secure during a procedure. Careful positioning prevents nerve compression injuries, especially around the arms, which are often placed on padded armboards.
How the Position Affects the Body
The downward slope causes blood and other bodily fluids to shift away from the head and chest toward the lower extremities. This fluid shift results in venous pooling in the legs, which decreases the volume of blood returning to the heart. This can potentially lower the preload and cardiac output.
Head elevation effectively lowers the hydrostatic pressure within the skull, making this position useful for reducing intracranial pressure (ICP). Studies show that this positioning can significantly lower ICP compared to a neutral position, even at a modest 10-degree tilt. The downhill slope also causes abdominal organs to shift away from the diaphragm.
This downward displacement relieves pressure on the diaphragm, allowing it to move more freely. Improved diaphragmatic movement facilitates better lung expansion and ventilation, benefiting patients with compromised respiratory function or obesity. This mechanical relief also decreases the risk of pulmonary aspiration.
Key Medical Uses
The physiological changes are leveraged across various medical and surgical specialties. A common application is in head and neck procedures, such as thyroidectomy, where the position reduces blood flow and minimizes bleeding at the surgical site. The reduced intracranial pressure also makes it suitable for selected neurosurgical and ophthalmic procedures.
In the operating room, the position is frequently used during laparoscopic surgeries of the upper abdomen, including gallbladder removal or bariatric procedures. Gravitational pull causes abdominal organs to fall downward, retracting them from the surgical field. This provides the surgeon with enhanced visibility and access, and allows for the use of lower insufflation pressures, which reduces patient discomfort.
Beyond surgery, the position manages symptoms related to the digestive system. Keeping the head elevated helps prevent the backflow of stomach acid into the esophagus, making it an effective tool for patients with severe gastroesophageal reflux disease (GERD). The improved lung capacity and reduced aspiration risk also make the position valuable in the intensive care unit for patients experiencing difficulty breathing (dyspnea) or post-operatively.