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Does proning help COVID-19 patients to improve oxygen levels?

Doctors believe this position helps in improving the oxygen flow in critical patients, making them less likely to be intubated or require ventilator support.

Published: 05th July 2020 07:21 PM  |   Last Updated: 06th July 2020 10:34 AM   |  A+A-

Proning

Image used for representational purpose only (Photo| Pulmonology Advisor)

Express News Service

CHENNAI: As the medical fraternity continue to figure out ways to prevent COVID-19 deaths, 'Proning' is one such technique, that has received acknowledgement from both government and private hospitals in Chennai.

What is proning? As the word suggests, it simply means to make a patient lie in the prone position, with chest and belly facing downwards. Doctors believe this position helps in improving the oxygen
flow in critical patients, making them less likely to be intubated or require ventilator support.

Health Secretary J Radhakrishnan said that lately, the government hospitals in the city have been following this. "We have been seeing good results in KMC and RGGGH and it is being done under the
supervision of senior allopathy doctors,'' he told New Indian Express.

Explaining the process, Infectious Diseases Specialist Dr Subramanian Swaminathan of Gleneagles Global Health City, said that proning is an age-old technique, normally used on patients with severe respiratory illnesses.

READ| Critical care team starts awake proning on patients not on ventilator

He added that when a person is in a prone position, owing to gravity, air moves up to the air-sacks. "This helps in better distribution of oxygen to lungs and other parts of the body,'' said Dr Swaminathan.

Since the progression of COVID is not catastrophic, this may result in some amount of improvement in patients in not requiring ventilator support. Proning is widely followed in other private hospitals too and doctors say it has given good results.

Dr Anantha Subramanian, Consultant Pulmonologist with Kauvery Hospital says that out of the 400 Covid-19 patients treated in the hospital, at least 60 to 70 per cent people were put in the prone position. "It was also tried on many patients aged above 60 and definitely they showed good improvement,'' he said.

Dr Subramanian said that the candidates for proning are those who have an oxygen saturation of 94 or below, and people with hypoxia too. "People who have spinal issues, neurological weakness and those who are uncomfortable are kept away from this,'' he added.

Recently, a statement from the Apollo Hospitals, too said that five patients who had severe breathing issues, including 65 and 72 year-olds, returned home safely after this mechanism was followed.

While anecdotal evidence of its efficacy come up, there are still no Randomised Control Trials for the success of proning on Covid-19 patients.

In a small cohort study published in the peer-reviewed Jama Internal Network Journal in the US, 25 patients, who required intubation, were studied for proning. In that, oxygen levels of 19 people improved above 95 per cent after one hour of prone position while oxygen levels of six patients did not improve.

Subsequently, out of the 19, seven required intubation and five out of the six, whose oxygen levels were low needed intubation. Totally, 12
were intubated out of the 25 finally, and three died in that.

In India, doctors from AIIMS in Jodhpur are conducting a larger study on proning, which is expected to go on till October.

Doctors, however, said that proning must not be solely relied on for improvement but other forms of treatment too must compliment it.

"Checking viral load in CT scan, steroids and usage of Tocilizumab is also part of the process,'' said Dr Swaminathan.



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