Lying on the stomach reduces lung pressure for Covid-19 patients

People infected with nCoV have acute respiratory failure, if they lie on their stomach, it will reduce pressure on the lungs and help oxygen enter the body more easily.

More than a year and a half of Covid-19 sweeping the world, doctors and scientists have drawn up many different treatments, from steroids, antivirals to plasma therapy. Among them, an effective and inexpensive technique, is to turn the patient over to relieve pressure on the lungs.

Follow New York Times, this is called the proning technique, which improves the breathing rate of people with respiratory failure. Lying on your stomach helps open the air passages in the lungs that have been compressed by fluid – a condition caused by nCoV.

Online consultation on VnExpress On the morning of July 24, Assoc. Prof. Dr. Nguyen Viet Nhung, Director of the Central Lung Hospital, also said that lying on his side and stomach when suffering from Covid-19 helps patients with breathing difficulties.

“Its mechanism is hemodynamic changes in the pulmonary vascular system. When lying on the stomach, the ventilation system is better, and the alveoli in the back are mobilized more,” said Nhung.

This can be applied to light F0 at home. However, Mr. Nhung recommended that cases of shortness of breath that require a definitive change of position should be taken to the hospital, unable to self-treat at home.

“The prone position alone is not enough to save our lives. We need to report when there are serious complications. When the respiratory rate is over 24 times a minute, if the oxygen saturation is below 94%, feel tired and very difficulty breathing, chest tightness, it is necessary to immediately notify the health system to be hospitalized,” he said.

Michelle Ng Gong, head of the intensive care unit (ICU), Albert Einstein College of Medicine and Montefiore Health System in the US, when the patient is lying on their back, the heart is on top of the lungs and puts pressure on it.

“The skeleton can’t function properly because it’s on the bed,” she said. If a person with Covid-19 lies on their stomach, the back of the lungs opens, allowing the alveoli to work more easily.

In addition, most of the lungs are located at the back of the human body. Therefore, when the patient lies on the stomach, the pressure on the lungs is minimized.

The illustration shows that when lying on the stomach, the lungs are above the heart, when lying on the back, the heart presses on the lungs and creates pressure. Photo: NY Times

Before the pandemic, proning techniques were used on people on ventilators, but not as often as they are today, partly because turning the patient upside down takes a lot of work. In 2013, French experts published a study in the New England Journal of Medicine, showing that patients with acute respiratory failure (ARDS) and requiring mechanical ventilation had a lower mortality rate if placed on their stomachs. Since then, depending on the severity of symptoms, American doctors have begun to turn over patients with signs of respiratory failure.

Later studies also showed similar results. However, before the pandemic, the prone technique was only used for about 15% of ARDS patients requiring intubation.

During the Covid-19 epidemic, many hospitals not only apply the above method to intubated people, but also patients with severe breathing difficulties. In the ICU, the doctor asks the patient to be turned on his or her stomach so that they don’t need to use a ventilator. In emergency rooms and common treatment areas, doctors try proning techniques for people with mild symptoms. In theory, this helps them recover faster.

“There’s a lot of evidence that proning actually reduces mortality,” said Dr. Corey Hardin, pulmonologist at Massachusetts General Hospital, USA.

In many patients with acute respiratory failure, only a small amount of alveoli collapse. Therefore, if intubated too soon, the pressure in the ventilator can inflate the uncollapsed alveoli.

At Massachusetts Hospital, about a third of ventilated Covid-19 patients are treated this way, often in the most severe cases. For people with milder symptoms, located outside the ICU, the medical team also recommends prone lying on their own. However, the time was shortened to 4 hours a day, because turning upside down for 16 hours without sedation was difficult.

A doctor examines a flipped Covid-19 patient at Rush University Medical Center, May 2020.  Photo: NY Times

A doctor examines a flipped Covid-19 patient at Rush University Medical Center, May 2020. Photo: NY Times

But experts still need to be careful when turning the patient upside down. “Some patients have very low blood oxygen levels,” says Dr. Gong. “The simple act of turning them to one side, not to mention turning them upside down, also causes oxygen levels to drop.” She also likens the technique to “a war”.

“You need to rotate their body so that it doesn’t blow up the tube, nothing accidentally falls out, doesn’t stop the patient from going into cardiac arrest. This requires teamwork,” she said.

In the US, to limit contact, hospitals arrange smaller groups of doctors to turn patients face down. The patient must lie on his back periodically, because this position is still more convenient for nursing work.

Thuc Linh


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