Heartbeat: Proning – protecting poorly patients with positioning

July 13, 2020

One of the most surprising developments to come from learning how to support COVID-19 patients has been the fact that simply positioning a patient in a prone position can significantly improve their clinical outcomes when used in an early stage.

Awake proning, the art of positioning a patient on their stomach, face down with pillows in strategic places has been shown to considerably improve the clinical outcomes for patients with acute respiratory infections such as COVID-19. The technique, which looks incredibly simple and only requires the use of six pillows and a bed, is designed to reduce pressure on the lungs by the heart and diaphragm and improve ventilation.

To find out more about the technique, Heartbeat caught up with Dr Eoin Dore CT2 to find out more. He said. “Awake prone position, when used at an early enough stage, can be extremely beneficial to patients and even in some cases be the

difference between them needing invasive mechanical ventilation. The method which involves moving the patient into a prone position with supportive pillows in strategic positions is something we can do easily in almost any environment, it doesn’t involve any complex or hard to come by equipment. By turning patients at regular intervals we take the pressure off the lungs, the fluid that has accumulated in the lungs moves to another region and the lungs are able to work more efficiently.”

“Ultimately awake proning as an early intervention may well reduce the number of ICU admissions. We know that intubation in COVID-19 patients has a high mortality rate so this is key to procedure to keep in your mind.

“We aim to move patients into a prone position usually for four hour periods, with an hour set aside each time where the patient can take a comfort break for eating, drinking and using the toilet. When patients are proned, pillows are placed under the head, chest, pelvis and shins; however, the abdomen should remain free and unsupported or compressed. Finally, the bed should be angled at least a 30 degree incline with the head at the highest point. Oxygen masks should remain in place and there shouldn’t be any need to wean patients down immediately. Improvements can take many hours to manifest.”

Be sure to check out this step by step instructional video below.