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Tuesday, July 5, 2022

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Proning: What it is and does it help improve Oxygen Levels in Covid Patients?

Proning position or sampling proning has recently become a very famous word. While the process is in use for over 40 years now. The same has gained new meaning under the harrowing second wave of COVID19 that has taken India by storm. With Oxygen shortage and panic going round most of the major cities in the country. Health Ministry too recently released a booklet on Proning. How it can help COVID19 patients under home isolation to improve oxygen levels.

But what is proning? How does it work, and does it really improve your oxygen levels? Read on to understand all about the position. How it works and most importantly – how does it help a COVID19 patient improve the all-important oxygen levels.

Proning or Prone Position: What is it

 Prone or Prone positioning simply put is the process of lying face down. The positioning, however, requires a certain elevation so as to maximize the impact of the same.

The process, however, is not new and not devised due to COVID. The process was first speculated and studies in 1974 for ARDS or Acute Respiratory Distress Syndrome. Suggested for patients with sedation and paralysis of the diaphragm. The positions was hypothesized to help in better expansion of the dependent dorsal lung region (roughly explained the lower back region). And in turn assist in better lung mechanics and in consequence better oxygenation.

To understand it better, it can be simply said that the position would relieve the pressure on the rear part of your lungs, helping them aerate or fill with oxygen more homogenously or equally.

Innumerous studies have been conducted all over the world to study the impact of prone positioning with people suffering from ARDS. Various theories (Sponge Lung and Shape Mechanics) have been investigated to understand the process and how it would help.

Proning and improved Oxygen Levels in COVID19 patients

Now that we roughly understand what proning or prone positioning is, let us try and answer the all important question – does it improve oxygen levels in COVID19 patients. With hospitals trying to manage the oxygen supply and beds running out quickly in major cities, ensuring oxygen levels in patients with COVID continues to be a big concern. Soon there were abundant claims that proning would help improving the oxygen levels considerably in patients. But is it true?

The simple answer it – it helps. Research found that ‘by turning the patient to the prone position due to thoracic-lung shape modifications the intrapleural pressure becomes less negative in non-dependent and less positive in dependent regions’. Furthermore, ‘not only the increase of regional inflation distribution in dorsal regions and decrease in ventral regions respectively, but intrapleural pressure, transpulmonary pressure and regional inflation distribution become more homogeneous throughout the lung’.

What does this mean? As explained earlier, the position was seen to assist the drainage of dead air trapped in lungs and helping and assisting in more ‘equal’ aeration of the alveoli or air bags in lungs. This, with more air filling in your lungs, would in turn assist in better oxygen supply to your blood, hence improving the oxygen levels.

How to do proning?

With the present situation in mind, the Ministry of Health and Family Welfare (MoHFW) released a detailed guide on Proning for self care. The document clearly lists out the do’s and don’ts of proning, how to position a pillow.

Simply, a person would need a bout 4-5 pillows – one to support the neck and keep the airway clear, about 2 below the chest and upper thigs and two below the shins. (see image).

Proning: What not to do

  • Remember not to stay in one position for more than 30 minutes.
  • Do not attempt proning an hour after meals
  • Do not stretch proning if not comfortable. Patients may adjust their pillows to accommodate the pressure
  • Avoid proning if you are pregnant, suffer from deep vein thrombosis (which was treated within less than 48 hours), suffer from major cardiac conditions and have an unstable spine, femur or pelvic fractures.
  • Patients whose oxygen levels have dipped below 90 must seek medial attention and consult their doctors.

Remember, otherwise healthy patients with minor symptoms of COVID may also use prone positioning to manage their oxygen levels. For patients who are not conscious, proning must be done by someone who is able to understand the instructions. At any time, however, if you feel that the breathlessness increases due to the positioning, discontinue and seek medical attention.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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