Trendelenburg Position under review

(from Canadian journal of emergency medicine)
Prospective studies

In a 1967 prospective study, Taylor and Weil tested the effectiveness of the Trendelenburg position in 6 hypotensive patients in clinical shock and 5 normotensive controls.3 In 9 of the 11 of patients, Trendelenburg positioning was ineffective, causing reductions in systolic, diastolic and mean arterial pressures. These authors noted that, in the head-down position, the viscera weigh down the diaphragm and compromise lung volumes. They also suggested that patients were at higher risk of cerebral edema, retinal detachment and brachial nerve paralysis.3

In 1994, Sing and colleagues4 assessed the impact of the Trendelenburg position on oxygen transport in 8 hypovolemic postoperative patients and found that it was associated with higher mean arterial blood pressure but not with improved cardiac output. Therefore, despite increases in blood pressure and left ventricle filling, there do not appear to be changes in tissue oxygenation during body tilting.4,5

In 1985, Bivins and coworkers6 studied the effect of the Trendelenburg position on blood distribution, finding that only 1.8% (99% confidence interval, -1.3% to 4.7%) of the total blood volume was displaced centrally when normovolemic patients were placed in the head-down position. They concluded that the autotransfusion effect produced by Trendelenburg positioning was small and unlikely to have an important clinical effect.6

Sibbald and cohorts investigated the effect of the Trendelenburg position on systemic and pulmonary hemodynamics in 76 critically ill patients (61 normotensive and 15 hypotensive) with acute cardiac illness or sepsis.7 In the normotensive group there was no change in pre-load or mean arterial pressure, but cardiac output increased slightly. In hypotensive patients there was no increase in preload or mean arterial pressure, but cardiac output decreased, suggesting that Trendelenburg positioning may be detrimental. These authors, like others, concluded that there were no demonstrable beneficial hemodynamic effects in hypotensive patients.1,3,7



1. Martin JT. The Trendelenburg position: a review of current slants about head down tilt. AANA J 1995;63:29-36.
2. Ostrow CL. Use of the Trendelenburg position by critical care nurses: Trendelenburg survey. Am J Crit Care 1997;6:172-6.
3. Taylor J, Weil MH. Failure of the Trendelenburg position to improve circulation during clinical shock. Surg Gynecol Obstet 1967;124:1005-10.
4. Sing RF, O'Hara D, Sawyer MA, Marino PL. Trendelenburg position and oxygen transport in hypovolemic adults. Ann Emerg Med 1994;23:564-7.
5. Terai C, Anada H, Matsushima S, Shimizu S, Okada Y. Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. Am J Emerg Med 1995;13:255-8.
6. Bivins HG, Knopp R, dos Santos PA. Blood volume distribution in the Trendelenburg position. Ann Emerg Med 1985;14:641-3.
7. Sibbald WJ, Paterson NA, Holliday RL, Baskerville J. The Trendelenburg position: hemodynamic effects in hypotensive and normotensive patients. Crit Care Med 1979;7:218-24.

Is Bed Rest An Effective Treatment Modality for Pressure Ulcers?

The following paper requires a thorough read:


Is Bed Rest An Effective Treatment Modality for Pressure Ulcers?
Your comment has been queued for moderation by site administrators and will be published after approval.
Matching equipment to meets client needs.
VOLUME: 50
Issue Number:
10
author:
Linda Norton, OT Reg (ONT); and Dr. Gary Sibbald, BSc, MD, FRCPC (Med), FRCPC(Derm), MACP, DABD, MEd

Look at the patient lying long in bed.
What a pathetic picture he makes.
The blood clotting in his veins,
the lime draining from his bones,
the scybola stacking up in his colon,
the flesh rotting from his seat,
the urine leaking from his distended bladder,
and the spirit evaporating from his soul.
— Dr. Richard Asher, British Medical Journal, 1947




Conclusion
Practitioners often express concern that medical and scientific studies are difficult to interpret for clinical use; however, in terms of the complications of bed rest, agreement between all existing sources is remarkable. Although illness severity may leave no choice except bed rest, the rest itself is rarely what is of benefit. Practically every organ and body system promptly and progressively deteriorates when it is inactive (see Table 4).2
In this time of focusing on best practices and patient outcomes, examining the practice of bed rest is appropriate. If effort were directed at conducting a randomized control trial to reevaluate the practice of bed rest, assuming that bed rest could speed the healing of pressure sores, the complications of this treatment are so well documented that this practice cannot be considered “safe.”
Alternatives to bed rest include optimizing the nutritional status of the client and managing pressure and shear throughout the client’s daily activities. Managing pressure and shearing forces outside of the bed may be one way to improve client outcomes and quality of life. - OWM
http://www.o-wm.com/article/3194

Experts: Sitting too much could be deadly - Boston.com

Experts: Sitting too much could be deadly - Boston.com

It's about time "the experts caught up" I have been researching this for 16 years and proven that posture is very important for maintaining circulation! Without circulation we are dust.

My research involves density changes in fluids from exhaling and constant water vapour loss from the skin and eyes.

Titlting the bed allows gravity to influence the density changes in the blood and in doing so assists the circulation.

Inclined therapy is where a person raises the head of the bed by 6 inches so the whole bed tilts from head to toe.

Poor Postural Advice for people with ms.

Andrew K Fletcher http://www.mstrust.org.uk/downloads/tips.pdf

Poor Postural Advice for people with ms.

Tips & Advice...

• Try to ensure that you get enough sleep - take naps during

the day if necessary. Give yourself permission to rest and put

your feet up whenever possible

• When you feel tired or worn out, stop what you are doing

and have a... rest before you start again - pace yourself

• Don't stand when you can sit down, and don't sit down

when you can lie down

• Be aware of your physical limitations and listen to your body

when it tells you to stop

• You might find that relaxation tapes and gentle music help

you to wind down

• If you know that you have a big event coming up that might

tire you out, make sure that you prepare for it, by getting as

much rest as possible beforehand


Flat bed rest advocated by an ms charity as the panacea for multiple
sclerosis. Yet proven to be a powerful degenerative influence on
healthy people, let alone some one with a neurological condition. There
are a huge amount of publications identifying flat bed rest as anything
but a safe and healthy sanctuary?


How many people with ms have read this harmful information and followed the advice only to find they have deteriorated rapidly?

People need to wake up to Inclined Therapy!

Human cerebral venous outflow pathway depends on posture and central venous pressure

J Physiol. 2004 Oct 1;560(Pt 1):317-27. Epub 2004 Jul 29.
Human cerebral venous outflow pathway depends on posture and central venous pressure.

Gisolf J, van Lieshout JJ, van Heusden K, Pott F, Stok WJ, Karemaker JM.

Department of Physiology, Room M01-07, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands. j.gisolf@amc.uva.nl.

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins.

Inclined Therapy or Sleeping in Sitting position

Are we Inclined To Sit Or Not To Sit?

Sleeping with the upper half raised is pretty much useless and may cause pressure sores.

Your weight when sleeping like this is compressing your spinal column.
It is also compressing the flesh and skin on your buttocks for many hours and this may eventually lead to the development of a pressure sore.

Your circulation is only assisted partially, but compromised because the same compression of the flesh in your buttocks together with the inevitable build up of venous and arterial pressure due to the veins and arteries affected by this compression will be counter productive.

Then there is the problem with stretched tendons and ligaments, bent forward, there is inevitably some tension applied to the muscles, tendons and ligaments. Over time this can have a detrimental affect

Last but not least are the joints in the hips and in the spine, If you are sleeping on your back, this means you are bent forward for 8 hours a day. Elderly people walking bent over, unable to straighten up, was that the position they slept in?
Sleeping on your side with the upper half raised will adversely affect the hip and spine joints, sleeping on your back will also adversely affect the spine. Sleeping on your tummy will result in someone calling an ambulance..

Inclined Therapy I.T.

Sleeping on an inclined bed however, does quite the opposite.

Immediately the spine is placed under gentle traction, (the opposite to the folded posture). The weight is distributed evenly so you don't feel like a sack of potatoes when you lay down, or the bed somehow feels softer than before.

Your heart rate decreases by 10-12 beats per minute on an inclined bed while you sleep, yet manages to pump more blood around the body, which in turn causes more friction as the blood flows around faster, which in turn generates more heat and you feel warmer in bed, while the cooling system also benefits so we are able to maintain our body temperature better as more water evaporates due to the increased / maintained temperature. Sleeping flat for instance causes a 2 degree drop in body temperature around the time that most people die in bed, yet sleeping inclined does not.

Your respiration rate decreases by 4-5 breaths per minute, which is a lot, yet oxygenation improves because the lungs are inflating more and deflating more which takes a little longer so although there are less breaths per minute a greater volume of air is moved in and out, which again increases the evaporation and this in turn alters the density of the surfactant in the respiratory tract which in turn alters the density of the surfactant that is returned back into the blood and gently assists the circulation as it flows through the arteries providing we are correctly aligned / Inclined.

But we don't just have blood circulating, we have lymph and cerebrospinal fluid, we have a flow of fluids through the tissue and skin, through the bones, and even a flow through the myelin wrapped around the nervous system. The heart is not responsible for these other circulations so cannot be attributed to them. Yet we know posture and respiration plays an important roll from the literature. So could all of these independent circulations require density changes from evaporation and correct alignment with gravity to gently assist them to make the repairs required to overcome a whole range of illnesses?

I believe this to be true and indeed have already proven it many times before.

What we are already seeing unfolding here on this forum is impressive and If Foreversprings and others posts are anything to go by we are in for a very exciting 2010.

I do not believe in the majority of cases surgery is required!

Varicose veins were believed once to require surgery, yet the surgery frequently fails requiring more expensive surgery, which raises the question why?

So many people have noticed their veins no longer ache or bulge using I.T. So rather than approaching this problem by patching up the damage, why not engage the possibility that given sufficient time using I.T. we may not require surgery and those that do not respond will probably require surgery?

Interesting times are afoot.

Happy New Year

Andrew K Fletcher

Inclined Therapy is again helping people with MS.

Dear Foreverspring

Thank you for your updates and for helping others to understand how tilting your bed has helped you.

Hopefully more people will join us and engage us with their own updates and your reports should stir up some thoughts about there being more to this simple therapy than one might think.

Really looking forward to seeing how many more people come back and report changes over the coming months.

Maybe a news team might eventually pick up on what is happening here and take an interest. This certainly would stir up a hornets nest with the medical profession and the charities.

Perhaps it might also lead on to the illusive controlled study that doctors are hiding behind as an excuse not to inform their patients about this simple common sense postural therapy approach.

On the Youtube video, the then senior director of the MSRC said "if it works let's get everyone trying it".

Well it is obviously working and why not because I.T. worked before he said it, and he knew it worked! and so did the director before him! And so did Peter Cardy at the MS Society!

It has taken us a few months to show how effective this therapy is for people with ms and the pilot study reports are confirmed by what is happening to people on this forum using I.T.

So let's do what the MSRC said they would and show people with MS that there is an alternative to drugs that is free, non-invasive and can be conducted in the comfort of our homes.

I have had tears in my eyes today thinking about the people this therapy has helped. Who cares whether hidden agendas from people paid to provide help matter more than helping people to get more out of life when you get results like yours?

So many people have said to me it's a miracle but miracles are one off's this is fully repeatable and to prove it here we are again after all these years providing anecdotal evidence for all to see and because it truly is repeatable do these results really qualify as being anecdotal? Do we really need approval from highly over paid non-contributing obstacles?

Or should we soldier on regardless and shame them into conducting their own studies if only to try to disprove that, which cannot be disproved?

Andrew K Fletcher