Covid-19 patients gasping for oxygen lining up outside hospitals across the country has been the defining image of the coronavirus pandemic in the second wave. Shortness of breath and fluctuating oxygen levels are among the major symptoms of Covid-19. However, not every patient facing breathing issues requires hospitalisation. The Union Health Ministry has recommended the technique of "proning" to help increase oxygen levels for those in home isolation. Proning is a technique in which the patient lies on the stomach, face down, to try and improve the oxygen levels in the body where the oxygen level between 94-100 is considered healthy.
How to do proning?
This simple technique may help patients breathe just by changing their body position. Here’s how Ziqitza Rajasthan and Ziqitza Limited Rajasthan help you to know how to do proning. All we need for proning are 4-5 pillows. The patient usually undergoes a series of manual turns that are done in a synchronized pattern. This includes:
Step 1: Turn the patient in the prone position (i.e., lying on the belly).
Step 2: Next turn the patient laterally (i.e., sideways) on the right side.
Step 3: Then make the patient sit up with the spine straight.
Step 4: Next turn the patient laterally (i.e., sideways) on the left side.
Step 5: Finally, turn the patient to the initial prone position.
Step 6: Alternate the position every 30 minutes.
Step 7: Each position requires the patient’s heart rate, blood pressure and pulse oxygenation level to remain stable during each move.
Step 8: It is advisable not to spend more than 30 minutes in each position.
It can be done as many times as tolerable. One can prone up to 16 hours a day in multiple cycles. While proning one must keep in mind injuries and pressure sores.
Why does proning work?
Flipping a patient on their stomach helps respiration because oxygenation getting more oxygen into the blood is easier in the prone position. ZHL Rajsthan further explains it's a function of anatomy, as the human body has more lung tissue in the back of the body than in the front. The coronavirus causes abnormal fluids and secretions to pool toward the back, where there's more lung tissue and leads to greater interference with lung function. When a patient is in the prone position, gravity helps the secretions move downward, so more of the good lung is on top and therefore less affected says Dr Datar Medical Director, Ziqitza Healthcare Ltd. (ZHL) Proning is also an effective treatment for a condition called acute respiratory distress syndrome, a life-threatening complication of coronavirus infection that manifests as shortness of breath and quickly progresses.
Where to place the pillows?
The pillows are arranged in the following manner to provide comfort to the patient:
Step 1: Place a pillow below the neck.
Step 2: Place 1 or 2 pillows below the chest and upper thighs.
Step 3: Place 2 pillows below the shins.
Step 4: Place 1 pillow below the head.
Things to take care while proning:
- Avoid proning for an hour after meals
- Maintain proning for only as many times as easily tolerable
- One may prone for up to 16 hours a day, in multiple cycles, as felt comfortable
- Pillows may be adjusted slightly to alter pressure areas and for comfort
- Keep track of any pressure sores or injuries, especially around bony prominences
When should you avoid proning:
- During pregnancy
- Deep venous thrombosis (treated in less than 48 hours)
- Major cardiac conditions
- Unstable spine, femur, or pelvic fractures
Ziqitza Limited says self-proning is a good way to boost oxygen levels at critical times when securing medical help may not be possible or manage symptoms at home. However, remember, it is only one of the ways that guarantees temporary relief and not a proper alternative for hospitalized care or oxygen support. Deep breathing, yogic pranayama, ample access to fresh air, staying hydrated, eating iron-rich foods, and light exercises also help in improving the oxygen level of patients while in home isolation.
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