NEW DELHI: The Union health ministry on Thursday advised 'proning for self care' for coronavirus patients, stating that it is extremely beneficial for such patients with compromised breathing comfort, especially during home isolation.
The ministry, in a document, said 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.
"Proning is a medically accepted position to improve breathing comfort and oxygenation. It is extremely beneficial in COVID-19 patients with compromised breathing comfort, especially during home isolation," the document stated.
Listing the importance of prone lying, the ministry said prone positioning improves ventilation, keeps alveolar units open and breathing easy.
"Proning is required only when the patient feels difficulty in breathing and the SpO2 decreases below 94 (less than 94). Regular monitoring of SpO2, along with other signs like temperature, blood pressure and blood sugar, is important during home isolation."
"Missing out on hypoxia (compromised oxygen circulation) may lead to worsening of complications. Timely proning and maintaining good ventilation could save many lives," the document said.
The ministry, however, cautioned to avoid proning for an hour after meals and maintaining it for only as much times as easily tolerable.
"One may prone for up to 16 hours a day, in multiple cycles, as felt comfortable. Pillows may be adjusted slightly to alter pressure areas and for comfort. Keep a track of any pressure sores or injuries, especially around bony prominence," it said.
According to the document, proning should be avoided in conditions like pregnancy, deep venous thrombosis, major cardiac conditions, unstable spine, femur, or pelvic fractures.
It also mentioned a five-step method to place a patient in the prone position in emergency using a regular bed, flat sheet, and family members.
It also issued a revised 'Clinical Guidance for Management of Adult COVID-19 Patients' recommending the EUA/off-label use of Tocilizumab drug in case of severe diseases, preferably within 24 to 48 hours of the onset of the disease or ICU admission.
The guidelines issued by AIIMS, ICMR-COVID-19 National Task Force and the Joint Monitoring Group (DGHS) under the ministry stated that Tocilizumab (a drug that modifies the immune system or its functioning) may be considered in patients with significantly raised inflammatory markers and not improving despite use of steroids with there being no active bacterial/fungal/tubercular infection.
They also recommended off-label use of convalescent plasma only in the early moderate disease, preferably within seven days of symptom onset, stating that "no use after seven days" and only on availability of high titre donor plasma.
Under emergency use authorization (EUA), Remdesivir may be considered for only those patients with moderate to severe diseases (requiring supplemental oxygen) within 10 days of onset of symptoms.
It is not recommended for those with severe renal impairment or hepatic dysfunction, the guidelines stated.
"Not to be used in patients who are not on oxygen support or in home settings," the ministry underlined.
The guidance note comes in the wake of increasing demand for Tocilizumab, Remdesivir and plasma, as the COVID-19 cases continue to surge.
The note specifies how and in what stages and doses should the drugs be used.
According to the guidance note, upper respiratory tract symptoms (or fever) without shortness of breath or hypoxia has been categorised as mild disease' and people have been advised home isolation and care.
The guidelines advise physical distancing, indoor mask use, strict hand hygiene.
symptomatic management (hydration, anti-pyretics, antitussive, multivitamins), staying in contact with treating physician, monitoring temperature and oxygen saturation (by applying a SpO2 probe to fingers) for such patients.
They should seek immediate medical attention if they develop difficulty in breathing, high grade fever/severe cough, particularly if lasting for five days.
A low threshold to be kept for those with any of the high-risk features such as 60 years of age, having cardiovascular disease, hypertension, chronic lung/kidney/liver disease or cerebrovascular disease or obesity, the note stated.