This simple technique may help patients breathe just by changing their body position.

By Claire Gillespie
Updated August 04, 2020
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Some doctors on the frontlines of the coronavirus pandemic are having success treating COVID-19 patients with a simple technique called 'proning.' The term basically means putting a patient in the prone position, or "flat on their belly with their chest and face down, rather than on their back,” Jack Stewart, MD, a pulmonologist with St. Joseph Hospital in Orange County, California, tells Health. 

Proning requires little or no equipment, and the technique may prove to help patients who are critically ill avoid being put on ventilators for breathing assistance. 

Why does proning work? Flipping a patient on their stomach helps respiration because “oxygenation (getting more oxygen into the blood) is easier in the prone position," says Dr. Stewart. It's a function of anatomy, as the human body has more lung tissue in the back of the body than in the front. The coronavirus causes abnormal fluids and secretions to pool toward the back, where there's more lung tissue, and leads to greater interference with lung function.

“When a patient is in the prone position, gravity helps the secretions move downward, so more of the ‘good’ lung is on top and therefore less affected,” Harry Peled, MD, a medical director in critical care at St. Jude Medical Center in Fullerton, California, tells Health.  

Proning is also an effective treatment for a condition called acute respiratory distress syndrome (ARDS), a life-threatening complication of coronavirus infection that manifests as shortness of breath and quickly progresses. A study published last month in JAMA Internal Medicine suggests that more than 40% of individuals in the study hospitalized for severe and critical COVID-19 developed ARDS—and over 50% of those diagnosed died from the disease.

ARDS poses a risk to patients who have influenza, pneumonia, and pulmonary edema (fluid in the lungs from heart disease) as well. “Proning has been used to treat ARDS for a number of years,” says Dr. Stewart. A 2013 study by French doctors published in the New England Journal of Medicine found that patients suffering from ARDS had a lower risk of death if prone positioning was used in the hospital early on. 

Further research on how proning affects coronavirus patients is needed, but anecdotal evidence shows the effectiveness of the treatment since the global pandemic began.

In the US, a coronavirus patient at Long Island Jewish Hospital managed to avoid needing life support after being put in the prone position, CNN reported. In the UK, a 50-year-old woman with COVID-19 pneumonia who doctors were convinced only had a “couple of hours” to live made a remarkable recovery after medics turned her onto her belly, according to an article written by the patient’s husband for The Times.  

Proning isn’t just being used for patients in critical condition. In fact, new guidance from the UK’s Intensive Care Society, written by doctors and nurses who specialize in intensive care and respiratory medicine, says the technique can reduce the need for invasive ventilation and the chance of death for conscious COVID-19 patients before they reach intensive care. 

“Prone positioning is a simple intervention that can be done in most circumstances, is compatible with all forms of basic respiratory support, and requires little or no equipment in the conscious patient,” states the new guidance. However, the technique is not suitable for all patients, such as morbidly obese people, pregnant women or those with facial injuries.

A team at Rush University Medical Center in Chicago is currently conducting a clinical trial to establish whether the prone position is helpful for COVID-19 patients who are not so sick that they need a ventilator to breathe for them, but sick enough to require supplemental oxygen delivered through a tube in their nose. 

Proning does come with some risks, such as pressure sores and dislodging of an endotracheal tube (a flexible plastic tube placed through the mouth and inserted into the windpipe to help a patient breathe), says Dr. Peled. The greatest risk is difficulty performing CPR if a patient goes into cardiac arrest. “It’s crucial to have a highly trained team and organized approach to ensure the procedure is performed safely and efficiently,” he adds. 

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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