Cardiopulmonary effects of the head-down tilt position in elderly postoperative patients: a prospective study

We studied the use of the head-down tilt position (Trendelenburg) in elderly postoperative patients in the intensive care unit to determine its effect upon cardiac and pulmonary function. Twenty-two patients (mean age 68.4 years) were placed in a 12 degrees head-down tilt position for 15 minutes. No deterioration was shown in any measured cardiac parameter; mean arterial pressure, cardiac index, and right and left ventricular stroke work increased significantly (P less than .05). Further, there were no observed changes in arterial or venous oxygenation, or in venous admixture. Because of the uncertain effect of the head-down tilt position upon cerebral blood flow, the routine use of this position is not recommended for the treatment of hypotension or during cardiopulmonary resuscitation. The results of this study, however, show that the cardiopulmonary effects are well tolerated if the position is required, as during central venous access procedures.