With the coronavirus still far from contained, scientists and medical professionals everywhere continue to look for viable treatments. However, it turns out that even some simpler solutions can also help save lives.
Dr. Mangala Narasimhan, the regional director for critical care at Northwell Health recently helped a Covid-19 patient at the Long Island Jewish Hospital by simply instructing her colleagues in the ICU to flip him on his stomach. This novel approach isn’t complicated, similar to how most NY hospitals started using large doses of Vitamin C to help their patients a month ago.
The reason turning Covid-19 patients on their stomachs saves lives is because this helps them breathe more easily by allowing more oxygen into their lungs. It’s called “prone positioning” and it’s not a new technique but very few doctors are applying it during the Covid-19 crisis.
Dr. Narasimhan stands by it, however.
“We’re saving lives with this, one hundred percent,” said Narasimhan. “It’s such a simple thing to do, and we’ve seen remarkable improvement. We can see it for every single patient.”
Other doctors also vouched for the prone positioning method. Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital added to Dr. Narasimhan’s statement by saying that “Once you see it work, you want to do it more, and you see it work almost immediately,”
The reason this is working is that a lot of the Covid-19 fatalities are actually due to ARDS – Acute Respiratory Distress Syndrome. As prone positioning improves breathing, it can help prevent the need for life support, at least for the time being.
How long have we known about this method?
The method has been well-known for a while. French doctors published an article about it in 2013 where they detailed how ARDS patients on assisted breathing had even higher survivability rates if they were placed on their stomachs as well.
Not all doctors have used this technique over the years but if ever there’s a time to adopt it, now might be it. The 40-year-old patient in the Long Island Jewish Hospital is an excellent example of that as the oxygen in his blood was shown to jump from 85% to 98% thanks to this method.
It can be an uncomfortable position to be in, of course. Ventilated patients have to stay on their stomachs for ~16 hours a day and the other 8 hours on their backs. Considering the benefits, however, the inconvenience may be worth the trouble.
“By putting them on their stomachs, we’re opening up parts of the lung that weren’t open before,” Dr. Hibbert explains.
Are there any other downsides to prone positioning?
One major drawback of this method is that some patients who remain on their stomachs for prolonged periods of time also need more sedation and that can often lead to staying longer in the ICU.
At Mass General, only the sickest patients get placed on their stomachs as they are the ones that gain the most out of this method.
When patients out of an ICU unit are asked to stay on their stomachs without any sedatives, it’s usually not for more than 4 hours at a time.
“Most are willing to give it a try,” Dr. Hibbert said. “How long they stay in that position really varies from person to person, whether they’re comfortable falling asleep in that position, or if they get bored and want to turn over to their backs.”
It’s not entirely clear how beneficial this method is for non-ventilated patients, as the 2013 French study covered only patients with assisted breathing.
The Rush University Medical Center is currently performing its own study into non-ventilated patients who’re utilizing prone positioning but their results aren’t out yet. In their ongoing clinical trial patients are assigned randomly whether they’ll be on their stomachs or their backs.
David Vines, chair of the cardiopulmonary sciences department at Rush explains that “We’ll see if proning helps, and if so, how long should they be in the prone position.”