What is the Trendelenburg position and when is it essential?

By Cristiano Antonino On Mar 2, 2023

The Trendelenburg position (TP) is a clinical technique in which the body is tilted into a supine position so that the head is lower than the body and legs

Doctors usually administer PT at an angle of about 16°.(1)

The modified Trendelenburg position (mTP) is a full body recline in which the head and body are level and the legs are slightly raised.(2)

Is the Trendelenburg position actually useful?

In reality, this has been a heated debate within the medical community for many years.

History and early uses

The creation of the Trendelenburg position is attributed to Friedrich Trendelenburg, a 19th century German surgeon.

Originally, surgeons used this technique to improve the exposure and visibility of the pelvic organs (3).

During the First World War, Walter Cannon, an American physiologist, was an advocate of PT as a treatment for shock.

After the war, the technique became commonly used.

As time passed, physicians began using PT to prevent air embolism during central venous cannulation and to increase the effectiveness of spinal anaesthesia.3

Cannon later revoked his recommendation of PT, which nevertheless remained popular within the medical community.

Arguments in favour of using the Trendelenburg position

Even today, many use PT as an immediate intervention to improve hypotension and hypovolemic shock.2

In addition, proponents claim that PT is useful for increasing venous return to the heart.

Therefore, the position increases cardiac output by promoting blood flow from the lower extremities.2

Surgeons also use PT on the operating table during operations on the lower abdomen and the placement of central venous catheters.

In addition, PT is commonly used in gynaecological and genitourinary procedures.1

Objections to the use of the Trendelenburg position

Although some physicians continue to boast its benefits, some believe that the Trendelenburg position is an obsolete technique that has no use in modern medicine.

Looking at the studies, it remains difficult to arrive at a clear answer.

Throughout history, studies on the Trendelenburg position have shown unsatisfactory results, at best.

For example, a 1967 study by Taylor and Weil tested the effectiveness of the technique on six hypotensive patients and five normotensive control participants.

Of these eleven patients, nine obtained no benefit from the Trendelenburg position.3

More recent studies have been conducted; however, a 2012 literature review proposed that the sample size was too small and the positive effects were minimal and temporary.2

The studies were also inconsistent in the administration of TP and/or mTP. This produces unclear results, at best.2

In addition to the lack of clinical evidence, some experts warn of the serious risks of using the Trendelenburg position.

For example, risks may include slipping, shearing and pressure injuries.

In addition, there is concern about tidal volume and lung compliance, venous stagnation towards the head, cerebral oedema, retinal detachment, brachial nerve palsy, decreased lung capacity and even aspiration.3, 4

Furthermore, experts advise against the use of the Trendelenburg position for obese and morbidly obese individuals.1

Is the Trendelenburg position really useful?

While some practitioners claim that the Trendelenburg position actually fulfils its clinical promises, others believe that the scientific evidence says otherwise and that the risks are substantial.

Each practitioner must combine scientific research with their own clinical experience to assess the needs of each individual patient.

With the completion of further studies, it is hoped to have a definitive answer on the clinical validity of the use of PT.

Trendelenburg position: when is it recommended?

The Trendelenburg position is also called anti-shock.

The reason? It is used when the patient is in shock during surgery, but not only: there are many situations that require the patient to lie down in this way and today we want to clarify them.

Trendelenburg position: when is it used and what does it consist of? A brief summary

The position is named after the German doctor Friedrich Trendelenburg, son of the philosopher of the same name, and is necessary, in the opinion of a significant proportion of doctors, in various situations

when surgery is required in a patient in shock
during particular radiological tests
during certain gynaecological and abdominal surgeries

In all these cases, the patient must be lying down so that the head is lower than the pelvis and knees.

The purpose is to use the force of gravity to have a greater perfusion (arrival of more blood) to the so-called noble organs, i.e. the brain, heart and kidneys.

This move is therefore necessary whenever blood circulates with difficulty in the human body and this can lead to loss of consciousness or haemorrhagic shock.

In addition, TP is also used in imaging.

Indeed, during an X-ray with contrast medium investigating possible gastro-oesophageal reflux.

Finally, it is also indicated when a natural birth is characterised by reduced dilation of the cervix or the unborn child is breech.

In all these cases, TP is very useful for a successful test and surgery.

Bibliographic references

Steris Healthcare. (2020, October 15). The Ultimate Guide to the Trendelenburg Position. Trendelenburg Position: Benefits and When to Use [with pictures] | Knowledge Center. Retrieved December 3, 2021, from https://www.steris.com/healthcare/knowledge-center/surgical-equipment/trendelenburg-position.
McGill University Health Centre: Division of Nursing Research and MUHC Libraries. (2015, October). Rapid Review‐Evidence Summary: Use of Trendelenburg for Hypotension. McGill University Health Centre. Retrieved December 2, 2021, from https://www.muhclibraries.ca/Documents/RR_Final-Report_Trendelenburg-Hypotension_OCT2015.pdf .
Johnson, S., & Henderson, S. (2004). Myth: The Trendelenburg position improves circulation in cases of shock. Canadian Journal of Emergency Medicine, 6(1). doi:10.1017/S1481803500008915
JEMS. (2020, December 21). The myth of the Trendelenburg position. The Journal of Emergency Medical Sciences. Retrieved December 3, 2021, from https://www.jems.com/patient-care/myth-trendelenburg-position-0/.