Why positioning Covid-19 patients on their stomachs can save lives

15 Apr, 2020

On Friday, Dr. Mangala Narasimhan received an urgent call. A man in his 40s with Covid-19 was in a dire situation, and her colleague wanted her to come the intensive care unit at Long Island Jewish Hospital to see if he needed to be put on life support.

Before I come over there, Narasimhan told the other doctor, try turning the patient over onto his stomach and see if that helps.
Narasimhan didn't need to go the ICU. The flip worked.

Doctors are finding that placing the sickest coronavirus patients on their stomachs -- called prone positioning - helps increase the amount of oxygen that's getting to their lungs.
"We're saving lives with this, one hundred percent," said Narasimhan, the regional director for critical care at Northwell Health, which owns 23 hospitals in New York. "It's such a simple thing to do, and we've seen remarkable improvement. We can see it for every single patient."
"Once you see it work, you want to do it more, and you see it work almost immediately," added Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital.

'We're opening up parts of the lung'

Patients with coronavirus often die of ARDS, or acute respiratory distress syndrome. The same syndrome also kills patients who have influenza, pneumonia and other diseases.

Seven years ago, French doctors published an article in the New England Journal of Medicine showing that patients with ARDS who were on ventilators had a lower chance of dying if they were placed on their stomachs in the hospital.
Ever since, to varying degrees, doctors in the United States have been placing ventilated ARDS patients on their stomachs.

Now they've doubled down on this with coronavirus patients, and it's paying off. When the patient at Long Island Jewish was placed on his stomach, his oxygen saturation rate, a measure of oxygen in the blood, went from 85% to 98%, a huge jump.
The ventilated patients typically stay on their stomachs for about 16 hours a day, going on their backs for the rest of the time so doctors have better access to their front side and can more easily give them the treatments they need.

Critical care specialists say being on the belly seems help because it allows oxygen to more easily get to the lungs. While on the back, the weight of the body in effect squishes some sections of the lungs.
"By putting them on their stomachs, we're opening up parts of the lung that weren't open before," Hibbert said.


Click on the link below for full text