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  • 06May, 2021

What Is Proning? How Does It Help Improve Oxygen Levels In Covid-19 Patients?

Somewhere between the rising death tolls in India due to Covid-19, the news of a 82-year old woman defeating covid in Gorakhpur, on April 28, 2021, has brought in hope for every struggling person. Using nothing but just a calm approach to battling challenges, she has proved to the nation that nothing is above willpower. Vidya Devi, a patient with high blood sugar and blood pressure was declared Covid-19 negative after 12 days of home isolation, According to her family members, she managed to bring up her oxygen levels not with the help of an oxygen cylinder but by lying in a prone position. Since then, people of all age groups have been practising the prone position for an effective outcome.

Covid-19 patients gasping for oxygen outside hospitals across India define the scary and gloomy devastation caused due to Covid-19 in the second wave. A sudden drop in the oxygen level and shortness of breath have been identified as the major indicators of Covid-19 infection.

With rampant covid-19 cases and shortage of beds in the hospitals, healthcare professionals have concluded that the proning can be a promising method to increase oxygen levels in Covid-19 affected bodies. Proning is a medically approved technique to reduce breathing difficulties and promote oxygenation.

What is proning?

Proning is the process of turning a patient with precise safe motions from their back onto their stomach so the individual is lying face down. Oxygen level (SpO2) between the range of 94-100 is considered healthy, and a drop below 94 could require medical assistance. The Union Health Ministry of India has recently recommended the ‘proning’ technique as an effective way to increase the oxygen level in Covid-19 patients who are in home isolation and have experienced a drop in oxygen level. 

If a patient is suffering from any respiratory disease, they should be turned onto their abdomen from lying on their backs. The practice has recently entered India amidst the rising deaths due to Covid-19. However, the technique has been in practice for ages in western countries. The patient needs to change the position of lying every 30 minutes. If the person lies on the belly for 30 minutes, the position needs to be changed to each side before going back to the normal position.

What do you need for proning?

If the oxygen levels drop down below 94%, all they need to do is lie down on their stomach. The patient will need four to five pillows for proning. One pillow should be placed below the neck, one or two pillows should be placed below the chest through the upper thighs and two pillows should be kept below the shins.

For self-proning, you will need:

  1. 4-5 pillows
  2. regular alterations in lying position

Do not spend more than 30 minutes in each position

Benefits of proning

What is the importance of proning?

  1. Proning improves ventilation, opens up the alveolar units and promotes easy breathing.
  2. Proning is required when the patients face difficulty breathing and the oxygen level drops below 94.
  3. During home isolation, regularly monitor the SpO2 level, along with blood pressure, sugar levels and body temperature.
  4. Timely proning and maintaining good ventilation could save lives.

What cautions are required to be taken for proning?

Proning is effective and easy. But there are a few cautions that people need to follow while performing the technique.

  1. Adjust the pillows slightly to alter pressure areas for maximum comfort.
  2. To not perform proning for at least an hour after taking a meal.
  3. Stay in a proning position only for as long as tolerable.
  4. Avoid putting pressure on areas that have injuries and sores, and the parts with bony prominences.

Why to prone a patient?

The alveoli permit the exchange of oxygen and carbon dioxide in the blood. When a person practices proning, the exerted pressure helps in the distribution and supply of air in the lungs which can directly affect the function of the alveoli. (Also read: How Does Covid-19 Affect Your Lungs?)

Sleeping on the back can have a detrimental impact on the pulmonary function in people with any underlying disease such as acute respiratory distress syndrome (ARDS) or mechanical ventilation. 

In the late 1970s, medical practitioners began investigating the potential benefits of putting patients with respiratory problems on their stomachs to treat ARDS. It was concluded by several clinicians that proning or laying a patient on their stomach brings a positive impact on the respiratory functioning of the patient.

Why is proning beneficial for ARDS patients?

People with ARDS are at a significantly higher risk of catching severe lung infection due to Covid-19. Globally conducted researches have found out the following benefits among patients with ARDS and hypoxemia. (Also read: Know everything about Covid-19 vaccine for 18+ in India)

  1. improvement in ventilation-perfusion matching
  2. improvement in ventilation of the dorsal lung areas affected by alveolar collapse
  3. improvement in mortality rate due to the low oxygen level

How to place a patient in a prone position in an emergency?

If you are not self-pronating and want to help a person in an emergency, here are the steps that you can follow:

1. Using a flat sheet of cloth, pull the patient to one side of the bed.

2. Place the flat sheet around the arm that will pull through (the side you are turning 

3. Use a second sheet, place it on the bed and tuck under the patient. As you turn the patient, this sheet will pull through.

4. Using the sheet, turn the patient over and place it on their stomach.

5. Place soft pillows as recommended above in the blog.

6. After 30 minutes, and centre the patient. Discard the sheet that was used to place the patient in the supine position.

What are the benefits of proning?

Who should avoid proning?

Proning should be avoided in any of the following conditions:

  1. major cardiac complications
  2. pregnancy
  3. deep vein thrombosis
  4. tracheal surgery
  5. pelvic fractures
  6. unstable spine or femur

Are there any risks to proning?

Although not common, proning can at times lead do the following complications:

  1. pressure-related skin injuries
  2. airway obstruction
  3. hypotension (low blood pressure)
  4. facial and airway edema
  5. dislodgement of the endotracheal tube
  6. irregular heart rate