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Covid-19 has instilled a sense of fear among people, especially with a surge in the number of cases, owing to the second wave that has ensued in India. By now, we are well-aware that the virus affects the respiratory system, and causes shortness of breath and lower oxygen levels. With the severity of this infection now, there is a growing need for supplemental oxygen, with many states reporting a shortage. Experts suggest that the normal oxygen level is 95 percent or higher.
In this case, alternative methods are being advised by experts to control the situation in an effective manner. One such solution is proning. Recently, India’s health ministry advised proning for ‘self care’ for coronavirus patients, adding that it is particularly helpful for those who are suffering from breathing problems, especially during home isolation.
So, what exactly is proning and is it effective? Let’s find out.
According to the ministry, proning is the process of turning a patient with precise, safe motions, from their back onto their abdomen so that the individual is lying face down. Experts suggest it is especially beneficial for patients, with or without ventilator needs—it allows for the expansion of the dorsal (back) lung regions, improves body movement and enhances removal of secretions, which helps a person breathe better.
What’s important to note is that proning is required only when the patient feels difficulty in breathing and the SpO2 decreases below 94 . Apart from proning, regular monitoring of SpO2, temperature, blood pressure and blood sugar is important for recovery.
The ministry document also states that missing out on hypoxia (compromised oxygen circulation) may lead to worsening of complications, while timely proning and maintaining good ventilation could save many lives. However, there’s a word of caution — proning must be avoided for an hour after meals, and must be maintained for only as many times as easily tolerable.
According to experts, the patient will go through a series of manual turns that are done in a synchronized pattern. The patients are moved sideways, followed by turning them on their side, and finally onto their abdomen. Each position requires the patient’s heart rate, blood pressure and oxygen levels to remain stable during each move.
The ministry suggests proning for up to 16 hours a day, in multiple cycles, based on comfort. Pillows may be adjusted slightly to alter pressure areas and for comfort. It should definitely be avoided in conditions like pregnancy, deep venous thrombosis, major cardiac conditions, unstable spine, femur, or pelvic fractures.
Yes, it does. Lying on the chest and stomach, or on the sides, helps the body get more air into all areas of the lung, as opposed to lying flat on the back. This technique has served beneficial to those with acute respiratory disease syndrome (ARDS), and is considered a ‘safe and simple method’ to improve oxygenation, as reported by the European Respiratory Journal, 2002.
Further, the study mentions that proning improves oxygenation, homogenizes the pleural pressure gradient, alveolar inflation and ventilation distribution, and increases lung volume. What’s more, proning helps to improve oxygen levels in 70–80 percent of patients with early acute respiratory distress syndrome.
“Awake proning delays the use of mechanical ventilation and facilitates the patients with severe ARDS or severe pneumonia in maintaining the supply of oxygen to the body tissues. Since medical institutes are overburdened and limited ventilators are available, awake proning can reduce not only the burden on hospitals but also decrease the need for ventilators,” as per a National Center for Biotechnology Information (NCBI) study ‘Awake Proning: A Necessary Evil During the COVID-19 Pandemic’ published in Cureus Journal in July 2020.