Postural changes to improve perfusion in acute hypovolaemia

Abstract

Early management of hypoperfusion in the field has included the use of patient postures that are believed to increase venous return and to subsequently increase cardiac output, resulting in an improvement in perfusion. These postures are usually a Trendelenburg (head down position with the lower body elevated approximately 30 centimetres) or a raised leg posture with the torso horizontal. Despite apparent acceptance of these postures in the management of hypotension due to hypovolaemia there is conflicting advice in paramedic textbooks regarding the use of these postures, and as such this study sought to locate and evaluate evidence relating to the efficacy of these postures in the early management of hypoperfusion. The results of the review failed to find evidence of efficacy arising from the prehospital setting. Evidence from other health settings was subsequently reviewed to synthesise recommendations for paramedic practice. No evidence of significant clinical benefit was located, and the use of these postures by paramedics to improve perfusion should be reviewed on the basis of these findings.