Proning

Claire Gillespie reports in Health,

Some doctors on the frontlines of the coronavirus pandemic are having success treating COVID-19 patients with a simple technique called 'proning.' The term basically means putting a patient in the prone position, or "flat on their belly with their chest and face down, rather than on their back,” Jack Stewart, MD, a pulmonologist with St. Joseph Hospital in Orange County, California, tells Health.

Proning requires little or no equipment, and the technique may prove to help patients who are critically ill avoid being put on ventilators for breathing assistance.

Why does proning work? Flipping a patient on their stomach helps respiration because “oxygenation (getting more oxygen into the blood) is easier in the prone position," says Dr. Stewart. It's a function of anatomy, as the human body has more lung tissue in the back of the body than in the front. The coronavirus causes abnormal fluids and secretions to pool toward the back, where there's more lung tissue, and leads to greater interference with lung function.

“When a patient is in the prone position, gravity helps the secretions move downward, so more of the ‘good’ lung is on top and therefore less affected,” Harry Peled, MD, a medical director in critical care at St. Jude Medical Center in Fullerton, California, tells Health.

Proning is also an effective treatment for a condition called acute respiratory distress syndrome (ARDS), a life-threatening complication of coronavirus infection that manifests as shortness of breath and quickly progresses. A study published last month in JAMA Internal Medicine suggests that more than 40% of individuals in the study hospitalized for severe and critical COVID-19 developed ARDS—and over 50% of those diagnosed died from the disease.

ARDS poses a risk to patients who have influenza, pneumonia, and pulmonary edema (fluid in the lungs from heart disease) as well. “Proning has been used to treat ARDS for a number of years,” says Dr. Stewart. A 2013 study by French doctors published in the New England Journal of Medicine found that patients suffering from ARDS had a lower risk of death if prone positioning was used in the hospital early on.

Read more here.