Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-19T01:24:32.741Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effects of Positional Change on Hemodynamic Parameters in Spinal Immobilization

Published online by Cambridge University Press:  04 November 2020

Emre Gökçen Open the ORCID record for Emre Gökçen [Opens in a new window]  and
Vahit Demir
Emre Gökçen*
Affiliation:
Asst. Prof. Dr., Department of Emergency Medicine, Bozok University Faculty of Medicine, Yozgat-Turkey
Vahit Demir
Affiliation:
Asst. Prof. Dr., Department of Cardiology, Bozok University Faculty of Medicine, Yozgat-Turkey
*
Correspondence: Emre Gökçen Department of Emergency Medicine Bozok University Faculty of Medicine Atatürk Road, Cemil Çiçek Street 66900, Yozgat-Turkey E-mail: emregokcenacl@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use.

Study Objective:

Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters.

Methods:

This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization.

Results:

A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°.

Conclusion:

The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.

Keywords

cervical collarinferior vena cava diameterleft ventricular outflow tract velocity time integrallong backboardspinal immobilization
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 67 - 73
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kwan, I, Bunn, F, Roberts, IG. Spinal immobilization for trauma patients. Cochrane Database Syst Rev. 2001;(2):CD002803.CrossRefGoogle ScholarPubMed
Fischer, PE, Perina, DG, Delbridge, TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care. 2018;22(6):659–661.CrossRefGoogle ScholarPubMed
Çorbacıoğlu, ŞK, Akkuş, Ş, Çevik, Y, et al. Effect of spinal immobilization with long backboard and cervical collar on vital signs. Eurasian J Emerg Med. 2016;15:65–68.CrossRefGoogle Scholar
Bunn, F, Kwan, I. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20(1):47–53.Google Scholar
Ham, W, Schoonhoven, L, Schuurmans, MJ, Leenen, LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg. 2014;76(4):1131–1141.CrossRefGoogle ScholarPubMed
Mobbs, RJ, Stoodley, MA, Fuller, J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72(6):389–391.CrossRefGoogle ScholarPubMed
Özdoğan, S, Gökçek, Ö, Katırcı, Y, et al. The effects of spinal immobilization at 20° on intracranial pressure. Am J Emerg Med. 2019;37(7):1327–1330.Google ScholarPubMed
Işık, GÇ, Demirci, OL, Çorbacıoğlu, ŞK, Çevik, Y. Effects of 20-degree spinal immobilization on respiratory functions in otherwise healthy volunteers with android-type obesity. Am J Emerg Med. 2020;38(1):60–64.CrossRefGoogle ScholarPubMed
Akkuş, Ş, Çorbacıoğlu, ŞK, Çevik, Y, et al. Effects of spinal immobilization at 20° on respiratory functions. Am J Emerg Med. 2016;34(10):1959–1962.CrossRefGoogle ScholarPubMed
Aksel, G. Effects of spinal immobilization at a 20° angle on cerebral oxygen saturations measured by INVOS. Am J Emerg Med. 2018;36(1):84–87.CrossRefGoogle Scholar
Kuster, M, Exadaktylos, A, Schnüriger, B. Non-invasive hemodynamic monitoring in trauma patients. World J Emerg Surg. 2015;10(1):11.CrossRefGoogle ScholarPubMed
Baker, JW, Deitch, EA, Li, M, et al. Hemorrhagic shock induces bacterial translocation from the gut. J Trauma. 1988;28(7):896–906.CrossRefGoogle ScholarPubMed
Blanco, P, Aguiar, FM, Blaivas, M. Rapid Ultrasound in Shock velocity-time integral: a proposal to expand the RUSH protocol. J Ultrasound Med. 2015;34(9):1691-1700.CrossRefGoogle ScholarPubMed
García de Casasola, G, Casado López, I, Torres-Macho, J. Clinical ultrasonography in the decision-making process in medicine point-of-care ultrasound in clinical decision making. Rev Clin Esp. 2020;220(1):49–56.CrossRefGoogle Scholar
Huggins, JT, Doelken, P, Walters, C, Rockey, DC. Point-of-care echocardiography improves assessment of volume status in cirrhosis and hepatorenal syndrome. Am J Med Sci. 2016;351(5):550–553.CrossRefGoogle ScholarPubMed
Ferrada, P, Murthi, S, Anand, RJ, et al. Transthoracic focused rapid echocardiographic examination: real-time evaluation of fluid status in critically ill trauma patients. J Trauma. 2011;70(1):56–64.Google ScholarPubMed
Nguyen, VT, Ho, JE, Ho, CY, et al. Handheld echocardiography offers rapid assessment of clinical volume status. Am Heart J. 2008;156(3):537–542.CrossRefGoogle ScholarPubMed
Hutchings, SD, Rees, PS. Trauma resuscitation using echocardiography in a deployed military intensive care unit. J Int Care Soc. 2013;14(2):120–122.CrossRefGoogle Scholar
Wilson, M, Davis, DP, Coimbra, R. Diagnosis and monitoring of hemorrhagic shock during the initial resuscitation of multiple trauma patients: a review. J Emerg Med. 2003;24(4):413–422.CrossRefGoogle ScholarPubMed
Pottecher, J, Ageron, F-X, Fauché, C, et al. Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma: retrospective analysis of a large regional trauma database. J Trauma Acute Care Surg. 2016;81(4):713–722.CrossRefGoogle ScholarPubMed
Bruijns, SR, Guly, HR, Wallis, LA. Effect of spinal immobilization on heart rate, blood pressure and respiratory rate. Prehosp Disaster Med. 2013;28(3):210–214.CrossRefGoogle ScholarPubMed
Yanagawa, Y, Nishi, K, Sakamoto, T, Okada, Y. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma. 2005;58(4):825–829.CrossRefGoogle ScholarPubMed
Lyon, M, Blaivas, M, Brannam, L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45–50.CrossRefGoogle ScholarPubMed
Sefidbakht, S, Assadsangabi, R, Abbasi, H, Nabavizadeh, A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol. 2007;14(3):181–185.CrossRefGoogle ScholarPubMed
Dipti, A, Soucy, Z, Surana, A, Chandra, S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med. 2012;30(8):1414–1419.CrossRefGoogle ScholarPubMed
Mookadam, F, Warsame, TA, Yang, HS, et al. Effect of positional changes on inferior vena cava size. Europ J Echocardiogr. 2011;12(4):322–325.CrossRefGoogle ScholarPubMed
Nakao, S, Come, PC, McKay, RG, Ransil, BJ. Effects of positional changes on inferior vena cava size and dynamics and correlations with right-sided cardiac pressure. Am J Cardiol. 1987;59(1):125–132.CrossRefGoogle ScholarPubMed
Panebianco, NL, Shofer, F, Cheng, A, et al. The effect of supine versus upright patient positioning on inferior vena cava metrics. Am J Emerg Med. 2014;32(11):1326–1329.CrossRefGoogle ScholarPubMed
Van Lieshout, J, Harms, M, Pott, F, et al. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans. Acta Anaesthesiol Scand. 2005;49(9):1287–1292.CrossRefGoogle ScholarPubMed
Cunningham, AJ, Turner, J, Rosenbaum, S, Rafferty, T. Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy. Br J Anaesth. 1993;70(6):621–625.CrossRefGoogle Scholar
Wiwatworapan, W, Ratanajaratroj, N, Sookananchai, B. Correlation between inferior vena cava diameter and central venous pressure in critically ill patients. J Med Assoc Thai. 2012;95(3):320.Google ScholarPubMed
Prekker, ME, Scott, NL, Hart, D, et al. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Crit Care Med. 2013;41(3):833–841.CrossRefGoogle ScholarPubMed
Arthur, ME, Landolfo, C, Wade, M, Castresana, MR. Inferior vena cava diameter (IVCD) measured with transesophageal echocardiography (TEE) can be used to derive the central venous pressure (CVP) in anesthetized mechanically ventilated patients. Echocardiography. 2009;26(2):140–149.CrossRefGoogle ScholarPubMed
Zaidi, A, Benitez, D, Gaydecki, PA, et al. Hemodynamic effects of increasing angle of head up tilt. Heart. 2000;83(2):181–184.CrossRefGoogle ScholarPubMed
Jans, Ø, Tollund, C, Bundgaard-Nielsen, M, et al. Goal-directed fluid therapy: stroke volume optimization and cardiac dimensions in supine healthy humans. Acta Anaesthesiol Scand. 2008;52(4):536–540.CrossRefGoogle Scholar
Harms, MP, van Lieshout, JJ, Jenstrup, M, et al. Postural effects on cardiac output and mixed venous oxygen saturation in humans. Exp Physiol. 2003;88(5):611–616.CrossRefGoogle ScholarPubMed
Chang, MC, Blinman, TA, Rutherford, EJ, et al. Preload assessment in trauma patients during large-volume shock resuscitation. Arch Surg. 1996;131(7):728–731.CrossRefGoogle ScholarPubMed
Grubb, BP, Kimmel, S. Head-upright tilt table testing: a safe and easy way to assess neurocardiogenic syncope. Postgrad Med. 1998;103(1):133–140.CrossRefGoogle ScholarPubMed
Critchley, L, Conway, F, Anderson, P, et al. Non-invasive continuous arterial pressure, heart rate and stroke volume measurements during graded head-up tilt in normal man. Clin Auton Res. 1997;7(2):97–101.CrossRefGoogle ScholarPubMed