Why Left Lateral Recumbent?

[AnthonyM83]

You hear it a lot to put altered patient "left lateral" or in "recovery position" but on their left side (even if NOT pregnant).

Is there scientific reason for the LEFT side, specifically?

I was originally told it was to prevent aspiration, but no one can really explain why the LEFT side.

I've heard:

- Stomach curves to the left, so vomit would have an extra curve to overcome

- Stomach curves to left, so contents won't be pushing against sphincter.

- In the ambulance, attendant can watch him better facing toward him.

- It helps pre-load by not having thoracic pressure on inferior vena cava

The first two don't quite sound legitimate enough. The third isn't great, because it only applies once patient is on gurney. Fourth does make sense, but it has nothing to do with aspiration and it assumes that all patients are in some kind of blood pressure / preload distress.

It would make sense as a position for a post-arrest patient who is now breathing or shock patients, perhaps. But why is it this big rule I seem to hear all over? Why must it be to the left side?

[Lone Star]

You hear it a lot to put altered patient "left lateral" or in "recovery position" but on their left side (even if NOT pregnant).

Is there scientific reason for the LEFT side, specifically?

I was originally told it was to prevent aspiration, but no one can really explain why the LEFT side.

I've heard:

- Stomach curves to the left, so vomit would have an extra curve to overcome

- Stomach curves to left, so contents won't be pushing against sphincter.

- In the ambulance, attendant can watch him better facing toward him.

- It helps pre-load by not having thoracic pressure on inferior vena cava

The first two don't quite sound legitimate enough. The third isn't great, because it only applies once patient is on gurney. Fourth does make sense, but it has nothing to do with aspiration and it assumes that all patients are in some kind of blood pressure / preload distress.

It would make sense as a position for a post-arrest patient who is now breathing or shock patients, perhaps. But why is it this big rule I seem to hear all over? Why must it be to the left side?

I've heard the same things for the same reasons. While the 'stomach thing' actually makes sense, as even a half full stomach would put the fluid level below the cardia, reducing regurgitation and subsequent aspiration risk. Since the great curvature is to the left, it stands to reason that any gastric content would therefore be spread out over a larger area, keeping the content level away from the cardia.

While in the ambulance, it's a little difficult to observe the patient's airway and signs of cyanosis if they're facing away from you. Even if you're in the 'airway seat' (immediately behind the driver), you've got to roll the patient back to the left (if they're right lateral recumbant), in order to do any interventions should the airway lose its patency.

I've only heard about relieving thoracic pressure/uterine pressure on the inferior vena cava for pregnant women.

[jwraider]

I have GERD and when I'm having a hard time laying down (regurgitation and reflux) the left side feels the best. I assumed it was basic gravity helping out. So maybe this position helps keep things down.

If I recall correctly left lateral recumbent position is a PT on their left side, with their right leg drawn up.

Reason #4501 I heard was with the lungs and left main stem bronchus being at an angle. I'm trying to remember why.

Maybe the answer is: D "all of the above"

This link almost makes it sound bad

It's late maybe I'll find the answer tomorrow or it will come back to me but I think it has to do with pulmonary function and the factors you listed.

[AnthonyM83]

Reason #4501 I heard was with the lungs and left main stem bronchus being at an angle. I'm trying to remember why.

That's reason 5. Most recent one I've heard, but couldn't recall it earlier.

Right lung has 3 lobes and is larger, so in case of respiratory distress or regurgitation, it would make sense to keep the "most useful" lung on top with least amount of pressure on it. If patient aspirates, at least it'll be "less useful" lung.

That one actually kind of makes sense, actually...

[chbare]

That's reason 5. Most recent one I've heard, but couldn't recall it earlier.

Right lung has 3 lobes and is larger, so in case of respiratory distress or regurgitation, it would make sense to keep the "most useful" lung on top with least amount of pressure on it. If patient aspirates, at least it'll be "less useful" lung.

That one actually kind of makes sense, actually...

Except, aspiration pneumonia, ARDS, septic shock and the such develop into systemic problems regardless of the location of the initial insult.

The reality of patient positioning is a bit more pragmatic. Position to best protect and manage the airway.

Take care,

chbare.

[Just Plain Ruff]

I tend to agree with CHBARE, you need to put the patient in the best position to protect the airway. If that means on their back then put em on their back but if they are protecting their airway fine then left lateral recumbant would be appropriate.

[AnthonyM83]

Except, aspiration pneumonia, ARDS, septic shock and the such develop into systemic problems regardless of the location of the initial insult.

The reality of patient positioning is a bit more pragmatic. Position to best protect and manage the airway.

So left side positioning it wouldn't help them days out, but would it help them in the short-term if they did throw up and aspirate large amounts? Not talking infection-wise, rather physical fluid covering alveoli bronchioles impeding air flow and gas exchange.

Is this LEFT lateral thing as common in other places as it is in California? Perhaps, because there's so many different unique cases where left would be good (pregnancy, facing toward bench seat in most ambulances, cardiac output problems) that they just started saying left lateral for everyone instead of explaining specifics? Or is there an actual reason why this term came about?

I really want to know. If there's no good reason, I'm going to start contesting it everytime I hear it...

[Just Plain Ruff]

So left side positioning it wouldn't help them days out, but would it help them in the short-term if they did throw up and aspirate large amounts? Not talking infection-wise, rather physical fluid covering alveoli bronchioles impeding air flow and gas exchange.

Is this LEFT lateral thing as common in other places as it is in California? Perhaps, because there's so many different unique cases where left would be good (pregnancy, facing toward bench seat in most ambulances, cardiac output problems) that they just started saying left lateral for everyone instead of explaining specifics? Or is there an actual reason why this term came about?

I really want to know. If there's no good reason, I'm going to start contesting it everytime I hear it...

I cannot remember the last time that I put someone in left lateral recumbent.

[chbare]

If somebody aspirates, it can quickly becomes a systemic problem regardless of the side.

I have yet to find definitive evidence that one side is the best. A study that some pregnant anesthesia techniques are better in one position, GERD may be better on one side, Left side may worsen CHF patients, ILMA works both sides among other types of research. However, no smoking gun.

Again, the best position may vary and a degree of flexibility is most likely the best choice.

Take care,

chbare.

[scope2776]

Somebody probably just made it up 100 years ago, and it was just grandfathered into all the textbooks and now it's regarded as LAW! Unfortunately, it probably requires a triple-blinded study to remove the myth b/c it's the "standard of care".

Left lateral recumbent / right lateral recumbent doesn't matter! evaluate your pt's airway and determine the appropriate way to clear their airway. Typically in semi-conscious patients who will react to deep suction it will be on their side; on unresponsive pt's i will typically be able to clear the pt's airway w/ suction while i attempt to control it.

Unfortunately, medicine has been boiled down into rigid algorithms in an attempt to teach the masses... it's easy to say and teach: "put all pt's on their L side who are vomiting" but hard to teach: "throughly evaluate your pt's airway and maintain it".