Doctors have found that placing the sickest coronavirus patients on their stomachs, called prone positioning, helps increase the amount of oxygen that gets to their lungs.
“We’re saving lives with this, one hundred percent,” Dr Mangala Narasimhan, the regional director for critical care at Northwell Health in the US, which owns 23 hospitals in New York, said.
On Friday, Dr Narasimhan received an urgent call from her colleague to attend to a man in his 40s with Covid-19.
Her colleague wanted Dr Narasimhan to come the intensive care unit at Long Island Jewish Hospital to put the patient on life support.
Dr Narasimhan told the other doctor to turn the patient over onto his stomach to see if that helps.
Dr Narasimhan didn’t need to go to ICU. The flip worked.
‘We’re opening up parts of the lung’
Patients with coronavirus often die of Acute Respiratory Distress Syndrome (ARDS), which also kills patients who have influenza, pneumonia and other diseases.
Seven years ago, French doctors published an article in the New England Journal of Medicine showing that patients with ARDS who were on ventilators had a lower chance of dying if they were placed on their stomachs in the hospital.
Ever since, to varying degrees, doctors in the United States have placed ventilated ARDS patients on their stomachs.
Now they’ve doubled down on this with coronavirus patients, and it’s paying off.
When the patient at Long Island Jewish was placed on his stomach, his oxygen saturation rate, a measure of oxygen in the blood, went from 85 per cent to 98 per cent.
The ventilated patients typically stay on their stomachs for about 16 hours a day, going on their backs for the rest of the time so doctors have better access to their front side and give them the treatments they need.
Critical care specialists say that laying on the stomach helps because it allows oxygen to get to the lungs more easily.
While on the back, the weight of the body in effect squishes some sections of the lungs.
“By putting them [patients] on their stomachs, we’re opening up parts of the lung that weren’t open before,” Dr Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital, said.
“Once you see it work, you want to do it more, and you see it work almost immediately,”
Choosing belly or back
There is a downside to placing ventilated coronavirus patients on their stomachs.
Ventilated patients require more sedation when they’re on their stomachs, which could mean a longer stay in the ICU.
At Massachusetts General Hospital, about one third of coronavirus patients on ventilators get placed on their stomachs, usually those who are sickest and have the most to gain from being in that position.
Some hospitals are also placing coronavirus patients who are not in the intensive care unit on their stomachs.
A “proning team” of nurses at Massachusetts General Hospital visit patients outside the ICU to encourage them to turn onto their stomachs.
Since it might be uncomfortable for a non-sedated patient to spend 16 hours on their stomach, the nurses try to get them to spend at least four hours, split into two sessions.
“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.”
The 2013 French study looked only at patients who were on ventilators, so it’s not clear what effect the stomach position has for patients who are not as severely ill.
The Rush University Medical Centre is currently studying whether the stomach position is helpful for patients who are not so sick that they need a ventilator to breathe for them, but sick enough that they need supplemental oxygen delivered through a tube in their nose.
In their clinical trial, patients are randomly assigned to be on their stomachs or backs, according to David Vines, chair of the cardiopulmonary sciences department at Rush.
“We’ll see if proning helps, and if so, how long should they be in the prone position,” Mr Vines said.
The worst is not over, the global pandemic has ‘certainly’ not peaked, according to the World Health Organisation.
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