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Why being face down is helping COVID-19 patients

HOUSTON – Puneet Patni, MD, from Kelsey-Seybold Clinic said while working in the ICU, it’s common to see COVID-19 patients face down on the bed.

“It is a bit of an undertaking to do but it’s simply putting the patient on their stomach, and typically for the first four days or so you want to do it for a good chunk of the day, for at least 16 to 18 hours if you can,” Patni said.

For the critically ill patients, the ones on ventilators, who may have acute respiratory distress syndrome or ARDS, being on their stomach (called proning) moves fluid from the back of the lungs to the front.

“When you put them on their stomach, there’s a better distribution of airway pressure … to inflate that section of lung. So, the areas of lung that need to be, need more pressure to be inflated where’s those that don’t need as much pressure don’t over-inflate,” Patni explained.

It’s a simple idea that Charles Cox, MD, of UT Health said is stolen from a helpful technique in children.

“It was stolen from the neonatalentologists. They figured out it’s a lot easier to flip a baby on their stomach when they have respiratory failure,” Cox said.

Should all patients try being on their stomach for as long as possible?

Patni says no.

“There isn’t even evidence for using proning prior to someone getting sick enough to be put on the ventilator and needing a lot of support,” he said. “People have tried and think ‘maybe we’ll just do a voluntary proning and if the patient is oriented and mentally able to understand what’s going on and ask them to lie on their stomach for as long as they can during the day,’ but there’s really not even data to support that. People have just kind of been trying things because of how serious this health crisis has been.”