Orthopneic Position

What Is It, Uses, and How It Helps Breathing

Author:Katie Arps, BSN, RN

Editors:Anna Hernández, MD,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy M. Johnson, LMSW

What is the orthopneic position?

Orthopneic position, sometimes called tripod position, is a sitting position where an individual leans slightly forward with their arms propped up on an overbed table or their knees.  Orthopneic position can be accomplished by raising the head of the bed to 90 degrees and placing a table with pillows across the bed in front of the individual. Additional pillows, typically behind the lower back, can be used to increase comfort and support. Alternatively, individuals can be assisted to a sitting position in a chair or on the side of the bed with a table in front of them. They may also use their knees for support. The orthopneic position is recommended for individuals experiencing shortness of breath, as this position maximizes lung expansion and is sometimes even spontaneously assumed by individuals on their own to lessen the effort of breathing. 

Illustration of an geriatric patient sitting in a chair and leaning forward with elbows on his knees.

Why is the orthopneic position used?

The orthopneic position is used to help decrease the breathing effort of individuals experiencing dyspnea or shortness of breath, primarily due to orthopnea. Orthopnea is dyspnea that occurs when an individual is lying down or reclining, known as a recumbent position. In this position, there is increased venous return from the legs and abdominal organs towards the central circulation of the heart, which increases the pressure in the pulmonary capillaries. In most individuals, this blood shift doesn’t cause any symptoms, but in certain conditions (e.g., heart failure or chronic kidney disease), it may cause fluid overload, resulting in pulmonary edema. Pulmonary edema refers to a fluid buildup in the lungs, thereby interfering with gas exchange and hypoxemia. Hypoxemia triggers chemoreceptors involved with respiratory drive, resulting in shortness of breath.

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How does the orthopneic position improve orthopnea?

The orthopneic position corrects the circumstances that cause orthopnea by positioning the individual out of a recumbent position. In individuals with heart failure who assume the orthopneic position, the extra blood volume in the heart and lungs can shift back towards the legs and abdominal organs, reducing pulmonary edema.  

The breathing effort an individual experiences is also decreased by assuming an orthopneic position because the anteroposterior diameter of the chest is increased, which allows for maximum chest expansion and increases the volume of air that can be inspired with each breath. Additionally, this position provides increased accessory muscles to aid in the effort required for breathing.

What are the most important facts to know about the orthopneic position?

The orthopneic position is a sitting position where the individual leans slightly forward with their arms propped up in front of them on an overbed table or their knees. This position can be used by individuals experiencing shortness of breath, especially orthopnea, a type of dyspnea that occurs when someone is lying down. Moving the individual out of the recumbent position eliminates the circumstances that cause orthopnea, thereby decreasing the work necessary to breathe by allowing greater chest expansion and increased ability to use accessory muscles.

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Pulmonary edema: Nursing

Resources for research and reference

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