In the year 1976, Dr Robert Brown and nurse Margaret Piehl had co-authored a paper. In the paper, they mentioned that proning helps patients suffering from deadly fluid build-up in their lungs. After this, proning was practised all over the world in patients suffering from respiratory distress. As the COVID-19 pandemic primarily affects the lungs, proning is also advised in COVID-19 patients suffering from respiratory problems.
Proning means lying the patient with the face down. It provides relief to the patient suffering from respiratory distress. The procedure was done long back in the patients suffering from Acute Respiratory Distress Syndrome (ARDS). Various studies have concluded that early initiation of proning in patients with ARDS results in reduced mortality.
Because of the respiratory system involvement in the current COVID-19 pandemic and reduced availability of medical care and oxygen beds, the importance of self-proning is revisited by several studies. Many of them revealed that the process is also effective in improving oxygen saturation in COVID-19 patients. The recent guidelines of the Ministry of Health and Family Welfare encourage proning at home in COVID-19 patients with respiratory issues.
There are various benefits of Self-Proning:
Buys time for medical help: Medical help is required in severe cases of respiratory distress. However, by the time medical help arrives, there must be a continuous supply of oxygen. Proning improves the level of oxygen saturation.
Improves oxygen saturation: In people with a moderate dip in oxygen levels, proning improves their oxygen saturation.
Relieves respiratory symptoms: Proning also helps in improving respiratory symptoms. It includes shortness of breath and low oxygenation.
Reduced requirement of supplemental oxygen: Proning reduces the need for supplemental oxygen. A study concludes that self-prone positioning in patients with COVID-19 pneumonia reduces external oxygen demand.
Reduces the need for ventilator support: Proning improves pulmonary ventilation and helps in keeping the alveoli open. It also prevents or reduces the build-up of fluid in the lungs. It may lower the requirement of a ventilator.
Self-proning is a highly effective procedure. It should be done through correct steps to attain maximum benefit. Self-proning guidelines are as follows:
Take five pillows. Keep two pillows under your shin (lower leg) region and the other two pillows in the abdominal cavity just below the navel. Ensure that you should not keep the pillow beneath the chest. Place one pillow under your chin or neck to support the head. Make sure that you position yourself so that there is a space between the chest and the floor. Now take a deep breath. Keep yourself in this position for around 30 minutes to 2 hours.
Change your position and lie on your left or right-hand side. Maintain this position for 30 minutes to 2 hours.
In this step, change your position and lie on the left-hand side. However, while changing position, you should pass through the prone position, as described in step 1, and hold there for few minutes. Lie on the left-hand side for 30 minutes to 2 hours.
Frequently Asked Questions
You need 4-5 pillows and it is necessary to change the lying position every 30 minutes. Place one pillow below under your chin or neck and two pillows in the abdominal cavity just below the nave, not below the chest, and two pillows below the shins.
Position 1: Lie on your belly for 30 minutes.
Position 2: Lie on your right side for 30 minutes.
Position 3: Sitting up position for 30 minutes with the support on the back.
Position 4: Lie on your left side for 30 minutes.
Position 5: Then back to position one- Lying on the belly.
Prone for up to 16 hours a day in multiple cycles as the patients feel comfortable.
People with the following conditions should avoid proning:
Avoid proning after eating food.
Pregnant ladies should not do proning.
If you are suffering from a pelvic fracture or have any disease related to the spine, proning may worsen your condition.
People with severe cardiac conditions should avoid doing proning.
Patients suffering from deep vein thrombosis should not do proning
Although proning is a simple breathing exercise that can be done at home, it is necessary to have some precautions while proning. Some of the precautions are:
Adjust yourself in a comfortable position.
You can do it for 16 hours a day in several cycles.
Do not practice it after eating food.
Take care of your injuries while proning.
Several studies have shown various benefits of self-proning in Covid-19 patients. There is an improved oxygen saturation after proning in COVID-19 patients. The oxygen requirement is reduced and the patients have a low risk of getting on ventilator support. It also helps in preventing the worsening of respiratory symptoms such as hypoxia or dyspnea.
Although proning is an effective procedure in improving oxygen saturation, it has certain limitations. It is not a life-saving technique when there is a fast dipping of oxygen saturation value. The procedure is not a substitute for oxygen cylinders and medical interventions. It may improve the oxygen saturation for a certain period until medical help arrives. If there is a rapid descent in oxygen saturation, call emergency as soon as possible.
Self-proning improves oxygen level through various mechanisms. It improves ventilation and redistributes blood flow. Proning reduces lung compression and promotes secretion clearance. It also manages ventilation/perfusion (V/Q) mismatch and improves oxygenation.
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