It is a technique that requires patients to lie on the stomach but takes six people to pull it off safely. Doctors say it is proving to be a “low-risk but highly effective” method to improve breathing coronavirus patients.
This helps prevent putting many patients on ventilators given the high mortality rate of patients put on ventilation, reports Yahoo Life.
A doctor at a Chicago emergency room said proning has been highly effective.
Explaining how it works, he said when we’re laying on our backs, our diaphragm is pushed up by our abdominal organs and our lungs don’t expand as much as they could.
Proning allows the diaphragm to sink low, because the abdominal organs are kind of falling with gravity, which allows the lungs to expand further and allows the back part of the lungs, which are normally being compressed when you're on your back to expand more, to allow for ventilation.
“So you're basically opening up more of the lungs to participate in gas exchange.”
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The rise of this technique in New York City can be traced to Dr Nicholas Caputo, associate chief of the ER department at Lincoln Medical Center in the Bronx, one of the hardest-hit hospitals in US.
He said in early March they used to intubate patients clearly experiencing respiratory problems early. But there were patients who did not show signs of respiratory distress. They were experiencing ‘silent hypoxics’ or breathing problem with no symptoms.
What this means is that the amount of oxygen in their blood (normally between 95 and 100) has fallen sharply.
Caputo said he and his team began considering alternatives to stop people being put on ventilators. They were inspired by a study conducted in Italy in late January where doctors found positive results from proning COVID-19 patients.
When ER staff started proning, within minutes of turning patients with low oxygen saturation on their stomachs, they saw oxygen saturation levels jump back into the normal range.
Caputo published the first clinical report of the progress on April 22. His report showed that proning improved the oxygen saturation levels among 50 individuals with COVID-19.
The technique has been adopted by other hospitals in New York and Caputo says it could be one of the reasons why the seriousness of infections has decreased.
“I’ve heard from physicians around the world, they've been trying this and they've been having pretty good success with improving oxygenation and holding off on intubating patients,” he says, noting that the numbers within New York City back that up.
By late March and early April, doctors were intubating several hundred patients a day but after proning became popular, that number dropped to a few dozen a day, he said.
Caputo noted that the technique is not perfect but hopes emergency rooms will adopt it.
“It’s not a panacea,” he says. “But it’s a way to buy time for some patients, and other patients, it’s a way to prevent intubation — cause we know this: If you get intubated, your odds of having a poor outcome in terms of mortality is around 50 percent.”