How Can Proning Boost Oxygenation In COVID-19 Patients?

Oxygenation is the most talked-about aspect of the Coronavirus treatment, as the country is grappling with the unprecedented shortage of medical oxygen. Difficulty in breathing is one of the most vital symptoms of COVID-19 infection. The Union Ministry of Health and Family Welfare (MoHFW) has strongly advocated the use of prone positioning, which is also a medically approved strategy. Accurate implementation of prone positioning requires turning the patient who is lying on their back safely to make him or her lie on their abdomen. Proning is a simple way to improve oxygen saturation in patients who have tested positive for COVID-19.

Understanding the Importance of Proning

Improvement of ventilation and oxygenation are vital goals of treating patients with Acute Respiratory Distress Syndrome (ARDS) that is associated with the Coronavirus infection. We can achieve these key objectives of Coronavirus treatment with the help of prone positioning, which has become a well-accepted technique across the globe.  

Most patients with Coronavirus infection are being advised of home isolation, as there is an acute shortage of hospital beds. Monitoring of following health parameters is of utmost importance during home isolation:

• Oxygen saturation (SpO2)
• Blood glucose levels
• Blood pressure
• Body temperature 

Oxygenation is essential if the SpO2 level of any Coronavirus patient falls below 94%. Proning is an easy and safe option that assures instant benefits to patients who have tested positive for COVID-19. Our lungs comprise alveoli, tiny balloon-like structures that facilitate breathing by exchanging oxygen with carbon dioxide. Proning boosts oxygenation and improves breathing by opening up these alveoli. There are hardly any options to improve the oxygen intake of a COVID-19 patient who is undergoing home isolation. In such a situation, prone positioning helps improve oxygenation so that the patient can breathe comfortably using no equipment.  

Proning does two things to get more oxygen to your body. It decreases the amount of weight and compression on your lungs, allowing more air to get to your alveoli (improved ventilation). Improves your lung efficiency by getting oxygen to the parts of your lungs that get the most blood flow (improved gas exchange).

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

How to Perform Proning Correctly?

Prone positioning is a medically advised procedure and is also being recommended as a supportive Coronavirus treatment to boost oxygenation. Proning needs to be performed appropriately by following the recommended guidelines. The correct proning approach will not only ensure the patient’s comfort but will also improve ventilation and oxygenation as desired.

Before beginning with the procedure of proning, one should keep four to five pillows ready to provide support at unique positions of the body. One has to provide support at specific positions for deriving the maximum benefits. 

• Step 1 – Make the patient lie down on his or her belly. 
• Step 2 – Position one pillow below their neck.
• Step 3 – Place one or two pillows below their chest and upper thighs as per the convenience of the patient.
• Step 4 – Position one pillow under both shins.

You should also include other positions besides the standard proning routine, such as lying down on the left side and right side. Combining these positions with regular proning will ensure the optimum exchange of oxygen and carbon dioxide at the alveolar level. The recommended period for every position is a minimum of thirty minutes to a maximum of two hours.   

Ventilators, oxygen concentrators and high-flow oxygen are essential elements in the fight against covid 19 especially in severe cases requiring hospitalisations since oxygen diffusion and transmission are seriously impacted in such patients.

Dr. Ashish Bajaj, MBBS, MD in Clinical Pharmacology and Toxicology

Useful Tips for Proper Prone Positioning

You should keep alternating proning positions while focusing on the comfort of the patient simultaneously. These positions are also ideal for self-proning while you are undergoing home isolation. You may adjust the pillows to make the patient feel comfortable and also to change the pressure regions. Pay required attention to any injuries or pressure sores while placing the pillows. 

According to the recent COVID-19 guidelines by the Ministry of Health and Family Welfare, proning should be done for a maximum of sixteen hours a day. There are few precautions to know and take before performing proning to support the Coronavirus treatment. 

These include avoiding proning immediately after meals and keeping the room sufficiently ventilated to facilitate the availability of fresh air. Second, proning should not be done at a single stretch, as it will cause strain. Ideally, one should keep an adequate interval between two cycles of prone positioning for greater convenience. 

Conclusion

For patients who are suffering from the COVID-19 infection, oxygen levels need to be maintained at an optimum value to prevent serious complications. Prone positioning is an extremely beneficial strategy to improve oxygenation and ventilation during home isolation or a hospital stay while the patient is undergoing Coronavirus treatment. You need to follow the steps and guidelines religiously to bring a noticeable improvement in SpO2 levels. Doctors strongly recommend checking SpO2 levels periodically to be on a safer side. 

Pregnant ladies should avoid proning as it may harm the foetus. Avoid proning if the patient is undergoing treatment for major cardiac diseases or deep vein thrombosis (DVT), which is treated in less than 48 hours. Doctors do not recommend proning for patients with pelvic fractures, unstable spine or femur. 

One should practice suggested positions of proning even if there is the slightest feeling of discomfort or difficulty in breathing. You can easily practice self-proning during home isolation if you can comfortably follow the guidelines with no help. Proning not only boosts oxygen saturation effectively but also reduces the need for any additional support for oxygenation. No wonder prone positioning is being strongly recommended as a routine for COVID-19 patients in India who are battling with falling SpO2 levels.  

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