As many people know, the coronavirus causes shortness of breath in many patients. While the World Health Organization reports that more than 80% of laboratory-confirmed cases were defined as mild-to-moderate, 14% are considered severe and 6% could be described as critical.
Oxygen levels in the blood are the most prominent predictors of prognosis, though lung damage that worsens by 50% or more within a 24 to 48-hour window also clues doctors in to a patient’s health status.
Getting oxygen to the lungs is one of the most major complications that comes along with the virus, but a new trick in hospitals is helping save lives of people sick with coronavirus.
Placing coronavirus patients on their stomachs helps them breathe
The tactic, called prone positioning, works because it allows patients more access to oxygen by opening up parts of the lung that weren’t open before. The oxygen is more easily able to get to the lungs in this position, while laying on your back causes the weight of your body to squish some sections of the lungs.
A patient at Long Island Jewish was placed on his stomach and his measure of oxygen in his blood jumped from 85% to 95%.
“We’re saving lives with this, one hundred percent,” Dr. Mangala Narasimhan, the regional director for critical care at Northwell Health, told CNN. “It’s such a simple thing to do, and we’ve seen remarkable improvement. We can see it for every single patient.”
Patients on ventilators generally lay on their stomachs for about 16 hours a day, switching to their backs for the remainder of the time so that doctors can more easily give them the treatments they need.
How was this trick discovered?
Those who have coronavirus often die of acute respiratory distress syndrome (ARDS), which is the same syndrome also kills patients who have influenza, pneumonia and other diseases.
In 2013, French doctors published an article that showed that ARDS patients on ventilators had a lower chance of dying if they were placed on their stomachs when hospitalized.
As a result of that article, published in the New England Journal of Medicine, doctors around the US have been placing ventilated ARDS patients on their stomachs.
Doctors have tested this practice with coronavirus patients, and the results are hopeful.
“Once you see it work, you want to do it more, and you see it work almost immediately,” Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital, told CNN.
The downside to putting patients on their stomachs
The one caveat to placing a ventilated patient on their stomach is that they require more sedation in this position, which could actually mean a longer stay in the Intensive Care Unit for them.
At Mass General, about a third of coronavirus patients who are on ventilators get placed on their stomachs because usually the ones who are sickest have the most to gain from that position.
At this hospital, there is what is called a “proning team”, or a team of nurses that visits patients not in the ICU in order to encourage them to turn onto their stomachs. Nurses try to get patients to spend at least four hours on their stomachs, split into two sessions, as it might be an uncomfortable position for them.
“Most are willing to give it a try,” 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.”
Does this trick help coronavirus patients who are not on ventilators?
The 2013 study only analyzed patients who were on ventilators, so it’s not clear if placing a patient on their stomach will help for a patient who is not as severely ill.
Doctors and nurses at Rush University Medical Center are studying whether the stomach position is helpful for patients who do not need ventilators to breathe, but are sick enough that they need supplemental oxygen delivered through a tube in their nose.
In the clinical trial, patients are randomly assigned to be on their stomachs or backs and monitored to see if the positions make any difference.