Prone ventilation as best treatment for covid patients

Proning means putting a patient in the prone position, or flat on their belly with their chest and face down. It requires little or no equipment, and the technique may prove to help patients and avoid being put on a ventilator. Flipping a patient on their stomach helps the respiratory system to work better because oxygenation (getting more oxygen in the blood) is easier in the prone position. It is 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 to pool towards the back and interfere with lung function. When a patient is in the prone position, gravity helps the secretions (substances discharged from a cell gland or organ) move downwards and it can reduce the need for ventilation and lowers the chances of death in patients.   

Why Proning?

Proning is an effective treatment in ARDS (Acute Respiratory Distress Syndrome) because ARDS is a condition that builds up fluid in your lungs and oxygen can not reach your lungs. Proning is standard care in patients suspected with COVID. The prevalence of ARDS among COVID patients is more as compared to other infections. 

Hemodynamics (blood flows through the cardiovascular system i.e. blood vessels) improvement in the proning act as a benefit in patients' health. When the patient is in a prone position during the process of proning, the heart falls forward on the sternum (long flat bone located on the central part of the chest) it doesn’t collapse on the lungs comparatively when the patient is laid on his/her back. Lungs can become very compressed when the patient lies down on his back because ribs on the back are relatively flat so when you are prone, the ribs have more curvature and it means that the patients have less flattened lung during the proning. 

Awake Proning in COVID-19

Patients who get infected from Coronavirus awake proning appear to be a fruitful method in COVID patients. COVID-19 is a primary respiratory illness like ARDS (Acute respiratory distress syndrome). If we have a look at recent scenarios, awake-prone therapy is the most beneficial method. This therapy is easy to perform and effective in patients it also helps in improving oxygenation and this whole process automatically leads to better outcomes in patients. Awake proning reduces the risk in intubated non-COVID 19 patients suffering from moderate to severe symptoms of coronavirus. 

Proning Technique

Every institution has its own protocols for specific COVID 19 treatment. Here is the generalized protocol which has been adopted by most of the institutions in order to perform this low-cost management strategy and effective therapy. 

• Oxygen therapy is required 

• Monitoring of blood pressure 

• Emergency buttons located near the bed of patients 

• Patients should be kept in the direct line of sight of the nurses and doctors. 

• Physician at the bedside of the patients. 

• Monitoring proning position of patients 

• Nurses and doctors follow up the therapy and checkup the patient for clinical assessment every 2-3 hours. 

Eligible patients for Proning 

• The heart rate of the patient should be at a stable position. 

• Communicate on their own for e.g. call for help or use the emergency button. 

• Normal blood pressure 

• Need oxygen therapy 

 Basics of Prone positioning 

• Encourage patients to do a rotation between sitting up, lying on the right and left side.   

• Avoid lying on the back 

• Encourage patients to stay in the fully prone position as long as they can. 

Proning helps the coronavirus patient in managing symptoms like shortness of breath and avoid the need for life support like ventilator after being put in the prone position.