How proning can help Covid patients

The effectiveness of ‘proning’ for patients with Covid-19 and its impact on reducing mortality has gained a lot of attention over the past year. Ministry of Health and Family Welfare (MoHFW) recently advised proning for self-care amongst patients who have tested positive for Covid, stating it to be highly beneficial. In the current scenario, when there is a shortage of hospital beds and drastically increased demand for oxygen concentrators and medication, it is seen that improvement in oxygen levels through proning may be very relevant to reduce the necessity of hospital admission.

What is proning?

Lying face down is known as proning. It is a medically accepted position to improve oxygenation. If a patient’s oxygen levels drop below 94 (when measured at home on an oximeter), the patient can lie on their tummy; this position improves ventilation and enables comfortable breathing.

Significance of proning

Physical position affects the distribution and volume of air in the lungs. It can directly affect the expansion of the lungs to permit the exchange of oxygen and carbon dioxide in the blood. In the last few years, prone positioning has been used increasingly in treating patients with Acute Respiratory Distress Syndrome (ARDS), and this is now considered a simple and safe method to improve oxygenation. It is a medically accepted process that involves turning a patient with precise, safe motions from their back onto their abdomen so that the individual is lying face down to improve breathing. Proning is required only when the patient experiences difficulty in breathing and the SpO2 decreases below 94. Regular monitoring of SpO2, along with other signs like temperature, blood pressure, and blood sugar, is important during home isolation. Moreover, missing out on hypoxia (compromised oxygen circulation) may lead to worsening of complications. Therefore, advice must be taken from the doctor on ways to effectively practice proning at home.

How to do proning correctly

One may prone for up to 16 hours a day, in multiple cycles, suitable to a patient’s comfort and ability. Pillows may be adjusted slightly to alter pressure areas and for comfort. Keep track of any pressure sores or injuries, especially around the bony prominence.

If this done with the help of a caregiver:

Place one pillow below the neck

Place one or two pillows below the chest through the upper thighs

Place two pillows below the shins

For self-proning:

You will need 4-5 pillows

Regular alterations in lying position

It is best not to spend more than 30 minutes in each position. After 30 minutes, lie on each side, then sit up before going back to proning

What are the precautionary measures that need to be taken?

Avoid proning if pregnant

Avoid proning for an hour after meals

Maintain proning for only as many times as easily tolerable

Keep track of any pressure sores or injuries, especially around bony prominences

Avoid proning if you have major cardiac conditions

Avoid proning if you have an unstable spine, femur or pelvic fractures

(The writer is an Infectious Disease Specialist from Mumbai)