A team of doctors at AIIMS Jodhpur is conducting an observational study to find whether prone positioning — making people lie on their bellies — can improve oxygen levels in Covid-19 patients.
The trial, which started recruiting patients this month, is expected to continue till October, according to a report published in The Print.
Maya Gopalakrishnan from AIIMS Jodhpur, who is leading the study, said, “Prone position has been tried in other diseases like ARDS, in which lungs are filled with inflammatory soup like fluid due to various reasons preventing normal gas exchange.”
She added, “In Covid-19, there were early social media reports where doctors found it useful. Further rigorous research studies are ongoing, including in our centre at AIIMS Jodhpur.”
Prone positioning & Covid Patients: feasibility and physiological effects
The COVID-19 pandemic has led to a substantial increase in the number of patients admitted to hospital with respiratory failure. Most of these patients require non-invasive ventilatory support; however, the failure rate (ie, worsening of condition or lack of improvement) is extremely high and intubation is often necessary, rapidly saturating resources and the availability of intensive care unit (ICU) beds, potentially leading to increased mortality.
Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 that occurs in 20–41% of patients with severe disease.
Treatment of ARDS requires tracheal intubation and mechanical ventilation, and patients can benefit from prone positioning, which has been shown to improve oxygenation and reduce mortality in non-COVID-19-related ARDS.
According to a study, published in The Lancet:
“Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake px with COVID-19-related pneumonia requiring oxygen supp. The effect was maintained after resupination in half of the px.”
DOI: 10.1016/ S2213-2600(20)30268-X pic.twitter.com/pCyswR5t95
— Orlando R. Pérez-Nieto (@OrlandoRPN) June 21, 2020
Increase in oxygenation is due to improved ventilation–perfusion matching in the prone position, because the dorsal areas (which anatomically have an increased number of alveolar units7) are no longer compressed by the weight of the abdominal cavity and the mediastinum, and can re-open, leading to recruitment of more gas-exchange-efficient regions.
The mortality benefit cannot be explained solely by improved oxygenation and has been linked to decreased overdistention and cyclic alveolar recruitment–de-recruitment within tidal breaths, with a decreased risk of ventilator-induced lung injury.
Very interesting.
If it works…it works!
Prone Positioning in Awake, Nonintubated Patients With COVID-19 https://t.co/9UHAj2EVGJ
— Roberto J. Vidrí (@RobertoVidri) June 18, 2020
Prone positioning is also a mainstay of treatment in COVID-19-related ARDS and has been recommended in the Surviving Sepsis Campaign COVID-19 guidelines.
