India is currently engulfed in the second wave of COVID-19 with a total of 20,31,977 active cases with states including Maharashtra in the midst of a lockdown. With the spike, several medical care experts including pulmonologists and chest specialists majorly treating coronavirus patients, are recommending proning - an activity in which patients are made to sleep on their stomach instead of on their back, to improve their lung function.
Proning is a technique that has been used for years to treat patients suffering from Acute Respiratory Distress Syndrome (ARDS) and cannot breathe on their own. While proning is normally conducted on ventilated, intubated patients, the COVID-19 pandemic has given rise to people using proning when not intubated to improve their oxygen levels by sleeping on their belly.
Doctors in India and abroad, have included proning as a regular part of their COVID-19 treatment protocol. The technique became popular after an Instagram post about COVID-19 cure talking about proning at home went viral.
BOOM spoke to Dr. Rahul Pandit, Intensive Care specialist at Fortis Hospital, Mumbai who is also a part of the Maharashtra's COVID-19 state task force to understand the effectiveness of proning technique. Pandit said that proning has been a part of the Maharashtra COVID-19 treatment protocol guidelines since April 2020. He explained,"Proning is a well-established scientific strategy that increase the functional residual capacity, improves secretion clearance and leads to oxygenation improvement. We have seen many patients recover because of it."
BOOM also reached out to Dr. Gunjan Chanchalani, Chief Intensivist, Bhatia hospital who co-authored a paper titled. 'Awake Proning: Current Evidence and Practical Considerations' to understand the process of proning. "It is known that SARS-CoV-2 affects the lungs and ventilators do not reach the dorsal and pos
terior parts of the lung, thus proning helps us open up those parts and allow circulation of oxygen," Dr. Chanchalani explained.
While sleeping on the belly seems easy to do for patients that are not connected to any ventilators or oxygen cylinders, it is recommended to be most effective for ventilated patients. A team of five medical professionals is required to assist in the process of prone ventilation.
"Two doctors, two senior nurses, and one or two junior nurses help the patient in achieving the prone position. As there are several tubes and pipes attached to the ventilator all of them are required to ensure that none of those are affected while changing from supine to prone. We have to check the patient's vitals- heart rate, oxygen, breathing while changing positions," Chanchalani said.
The patients are kept in proning positions starting from 14-18 hours and supine in the remaining. If the patient can manage to sleep on their belly for longer, the hours are extended, Dr. Chanchalani said, further adding, "The nurses are always around if the patient needs to move their hand, change the position of their head so that they do not have any sores. We even give them cushions."
Dr. Chanchalani in her paper has reviewed studies that show the effectiveness of proning in decreasing the severity of COVID-19. Studies across China, France, Italy, Singapore, USA conducted during the last year have shown that proning has assisted in improving lung function significantly.
An IAS officer, Dev Choudhary displayed how the process is supposed to be conducted and even explained the merits of proning.
