With the growing number of coronavirus cases yet again, every minute records at least 2-3 persons getting diagnosed with Covid-19. Although the symptoms remain more or less the same with the addition of gastrointestinal issues and rashes for the newer variants of the virus, it is the sudden dip in oxygen level without knowing that is more fearsome and a major reason of concern. Last Thursday, on April 22, the Union Health Ministry advised 'proning for self-care' for coronavirus patients, stating that it holds high significance for covid positive patients with compromised breathing comfort, especially during home isolation or self-care treatment at home.
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So, What Is Proning, You Ask?
Proning is a medically accepted process of turning a patient with precise, safe motions from their back onto their abdomen (stomach) so the individual is lying face down. It is pivotal in improving breathing comfort and oxygenation in Covid-19 patients especially during home isolation.
How Does Proning Help In Covid Positive Patients?
Proning allows for better expansion of the dorsal (back) lung regions, improves body movement and promotes the removal of secretions which may ultimately lead to advances in oxygenation (i.e., breathing). Several scientific studies state that proning is pivotal for some patients who experience mild respiratory distress and do not need a ventilator as it actively prevents progressing the condition to severe respiratory distress and shows improved signs of oxygenation.
Although there is no scientific evidence whether proning totally mitigates the patient's need for a ventilator, rather it just improves the oxygen levels temporarily in patients suffering from mild symptoms of Covid-19.
Where To Place The Pillows?
The pillows are arranged in the following manner to provide comfort to the patient:
Step 1: Place a pillow below the neck.
Step 2: Place 1 or 2 pillows below the chest and upper thighs.
Step 3: Place 2 pillows below the shins.
Step 4: Place 1 pillow below the head.
How To Do Proning?
The patient usually undergoes a series of manual turns that are done in a synchronized pattern. This includes:
Step 1: Turn the patient in the prone position (i.e., lying on the belly).
Step 2: Next turn the patient laterally (i.e., sideways) on the right side.
Step 3: Then make the patient sit up with the spine straight.
Step 4: Next turn the patient laterally (i.e., sideways) on the left side.
Step 5: Finally, turn the patient to the initial prone position.
Step 6: Alternate the position every 30 minutes.
Step 7: Each position requires the patient’s heart rate, blood pressure and pulse oximetry (oxygenation level) to remain stable during each move.
Step 8: It is advisable not to spend more than 30 minutes in each position.
Who Can Perform Proning On A Patient?
Although self-proning can be done in emergency times if there is no one around, however, it is advisable to ask well-trained personnel to help out the patient in doing proning. These people include:
- Registered and trained nurses (with either critical care or operating room expertise)
- Physical therapists/occupational therapists/patient care technicians
- Respiratory therapists
- Anesthesia physicians
When Is Proning Necessary?
Proning is extremely necessary only when the patient feels difficulty in breathing and the SpO2 decreases below 94. According to the health ministry, it is pivotal to regularly monitor the SpO2 readings using a pulse oximeter, along with other signs like temperature, blood pressure and blood sugar, during home isolation to prevent deterioration in health.
How Long Can A Patient Be Proned?
A patient can be proned for up to 16-18 hours a day, in multiple cycles, as felt comfortable. Afterward, the patient must be then placed in the supine position (lying horizontally with the face and torso facing up) for 6 to 8 hours if the oxygen levels are able to tolerate it. The pillows used are adjusted slightly to alter pressure areas and provide comfort.
When And Who Shouldn’t Do Proning?
It is highly advisable not to do proning directly after having a meal. Ensure that there is at least a gap of one hour after meals.
It is also strictly advised for pregnant women, people with cardiac conditions, or having an unstable spine, people having pelvic fractures, open wounds, burns or tracheal surgery to avoid proning until prescribed by a critical care physician and/or a pulmonologist and determined whether a patient is a “good candidate” for proning.
Are There Any Side-Effects To Proning?
A well-trained person is extremely necessary to do proning. If the movements are not carried out slowly in a synchronized manner, it may lead to the following conditions: