BENGALURU: To reduce the number of Covid deaths in the state, the Critical Care Support Team (CCST) of Karnataka five days ago started “Awake Proning” on non-intubated patients to reduce the number of high-risk patients getting into a critical stage. The procedure is to make patients lie on their stomach, which increases oxygenation by helping recruit posterior portions of the lungs and by allowing perfusion of oxygenated lung segments.
Dr Anoop Amarnath, Chief, Clinical Services, Manipal Hospitals, and a CCST member, said, “This is usually done on patients who are on ventilator and it is called prone ventilation. We were already doing that. But we have set a new protocol and allowed its use on patients who are not on the ventilator as well.”
The Union Ministry of Health and Family Welfare on June 13 included early self-proning in awake non-intubated patients under its protocol and it was adopted by the state government after getting approval from experts.
The guidelines specify that the patients be kept prone for 16-18 hours a day. But pregnant women and those suffering from cervical spondylosis are excluded as it is not safe for them. The typical protocol includes 30-120 minutes in prone position followed by 30-120 minutes of lying on left, right and sitting positions.
Dr Anoop said, “The patients do not have to lay prone for 16 hours continuously. They can take breaks too. Trials in Europe, New York and China have proved successful. The procedure is low risk, low cost and helps patients reduce the need for intensive care.” Special Officer, CCST, Dr Thrilok Chandra, said awake proning has been carried out on 50 patients.
“We had selected some patients requiring high-oxygen flow and who can tolerate the proning effectively and tried it on them. This helped them largely.” The patients may experience nausea, vomiting and musculoskeletal discomforts, but doctors monitoring them will ensure breaks in between.