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In the year 1976, Dr. Robert Brown and nurse Margaret Piehl 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.
Self- Proning for Coronavirus
Proning means lying the patient face down. It provides relief to the patient suffering from respiratory distress. The procedure was done long back in 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 the 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. Consult today with the best pulmonologist in Bangalore if you are having respiratory issues.
Advantages of Self-Proning at Home
There are various benefits of Self-Proning:
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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.
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Improves oxygen saturation
In people with a moderate dip in oxygen levels, proning improves their oxygen saturation.
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Relieves respiratory symptoms
Proning also helps in improving respiratory symptoms. It includes shortness of breath and low oxygenation.
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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.
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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 Procedure for Covid
Self-proning is a highly effective procedure. It should be done through the correct steps to attain maximum benefit. Self-proning guidelines are as follows:
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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 do 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.
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Change your position and lie on your left or right-hand side. Maintain this position for 30 minutes to 2 hours.
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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 a few minutes. Lie on the left-hand side for 30 minutes to 2 hours.
Conclusion
Self-proning is a simple and effective process for improving blood oxygen levels. The procedure is found to be effective in COVID-19 patients. Proning improves ventilation and reduces respiratory symptoms. It also helps in preventing fluid build-up in the lungs. If after taking all the precautionary measures, you are not feeling well, visit the best pulmonology hospital in Bangalore or anywhere near you.
Frequently Asked Questions
1. How to prone a Patient to COVID-19?
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 two pillows in the abdominal cavity just below the nave, not below the chest, and two pillows below the shins.
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Position 1: Lie on your belly for 30 minutes.
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Position 2: Lie on your right side for 30 minutes.
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Position 3: Sitting up position for 30 minutes with the support on the back.
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Position 4: Lie on your left side for 30 minutes.
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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.
2. Who should not do proning?
People with the following conditions should avoid proning:
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Avoid proning after eating food.
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Pregnant ladies should not do proning.
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If you are suffering from a pelvic fracture or have any disease related to the spine, proning may worsen your condition.
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People with severe cardiac conditions should avoid proning.
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Patients suffering from deep vein thrombosis should not do proning
3. What precautions to take while proning?
Although proning is a simple breathing exercise that can be done at home, it is necessary to take some precautions while proning. Some of the precautions are:
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Adjust yourself in a comfortable position.
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You can do it for 16 hours a day in several cycles.
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Do not practice it after eating food.
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Take care of your injuries while proning.
4. How effective is self-proning in patients with COVID-19?
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.
5. What are the limitations of self-proning in COVID-19 patients?
Although proning is an effective procedure for 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.
6. How Self-Proning Improves Oxygen Levels?
Self-proning improves oxygen levels 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.
