Trendelenburg and Anti-Trendelenburg Explained

Trendelenburg

The Trendelenburg position is a feature integrated into most modern-day profiling and adjustable care beds. The position involves placing the patient’s head down and elevating the feet, resulting in their whole body sloping down with the feet at the highest end. The picture below shows a high dependency bed in the Trendelenburg position with the mattress platform profiling.

History of the Trendelenburg position

Friedrich TrendelenburgThe Trendelenburg position is named after German surgeon, Friedrich Trendelenburg (pictured), who created the position in 1881 to improve surgical exposure of the pelvic organs during surgery. The Trendelenburg position is supine (body is laid flat on the back) with the patient inclined, so that the pelvis is higher than the head by 15-30 degrees. This allows better access to the pelvic organs as gravity pulls the intestines away from the pelvis. The Trendelenburg position became better-known in the first world war when Walter Cannon, a famous American physiologist, adapted the use of the Trendelenburg position as a treatment for shock, with the thought that it would help maintain blood flow to the brain. It was promoted as a way to increase blood circulation throughout the body, improving the flow of blood vessels to the heart and other organs.

The Trendelenburg position had several uses which are now outmoded. One such example is people with hypotension (low blood pressure), who were placed in the Trendelenburg position in the hope of increasing the blood pressure to their brain. As recently as 2008, a combined scientific studies found adverse consequences to the use of the Trendelenburg position for treating hypotension, and recommended it be avoided. Another obsolete use for the Trendelenburg position, was the use with injured scuba divers. Although some still use the position, today’s scuba first aid professionals no longer advocate elevating the feet higher than the head, pointing to increases in regurgitation and airway problems, brain swelling, increased breathing difficulty, and no real proven value.

Trendelenburg position today

Today, the Trendelenburg position is used in a number of medical and surgical situations. A specific example is the help the position provides in surgical reduction of an abdominal hernia, but there are more wider uses such as its use in respiratory patients to create better perfusion (blood flow to organs). View more information about today’s uses for Trendelenburg on Wikipedia. Click here.

Anti-Trendelenburg position

Anti-Trendelenburg, or Reverse-Trendelenburg, is where the head is elevated higher than the feet, by 15-30 degrees. The patient still lies in a supine position (on their back). This position has benefits in surgical operations and medical procedures, an example being its use to expose the prostate and upper abdominal region during surgery. The Anti-Trendelenburg position also helps respiration for overweight and obese individuals during surgery by relieving the head, where pressure often builds up during surgery.

However, there are some known risks such as hypotension, which is a drop in heart rate and pulse, body temperature and blood pressure. This means the patient must be constantly monitored while in this position to avoid these health risks. Blood circulation is also hindered in the anti-trendelenburg position. Overall, this position is good for head and neck procedures, because blood flow is reduced to the brain, neck, and genital area.

Trendelenburg positions in care beds

Hospital Bed TrendelenburgToday, a lot of profiling care beds (such as these) have the Trendelenburg and Anti-Trendelenburg functions. Whilst it is increasingly rare to use this function for medical purposes in a care environment, they do provide additional posture control and practicality. When combined with a profiling mattress platform, the Anti-Trendelenburg position can be used to form the mattress into a near seated position, see picture to the right. This allows users with restricted mobility to sit  right up in bed. Trendelenburg also allows an individual to raise their legs, a particularly useful function if they have a condition that requires restricted blood flow to the feet.

However, if these positions are used on an individual for a long period of time, it can result in serious harm and sometimes fatality. It is essential when buying a care bed for users with limited mental capacity, or dementia and dementia-related illnesses, that the handset that controls these Trendelenburg functions has a secure locking device which the carer can activate for when they are not present with the individual. This will prevent the individual from innocently or accidently actioning the Trendelenburg functions, and causing themselves serious harm.