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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
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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
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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