Have you ever seen a patient in the intensive care unit (ICU) who is having severe difficulty breathing, being carefully turned face down by the doctors and nursing staff? You may have wondered why they do this, and whether it would be uncomfortable for the patient. This is actually a very important treatment method that can save the patient's life. Today we are going to talk about this special method that is new to many people, but has been used in medicine for decades. This is called "Proning" in medicine.
What is simply proning?
Simply put, proning is the act of turning a patient who is lying supine (on their back) into a prone position (on their stomach). In medical terms, this sleeping position is called the ``Supine Position''. The ``Prone Position'' is used by doctors to help patients with severe respiratory conditions who have difficulty getting enough oxygen to their bodies.
This method is often used for patients who are on mechanical ventilation. You may have heard this term during the COVID-19 pandemic. But it is nothing new. Studies have even found that if this method is used early in patients with severe respiratory illness, the risk of death can be significantly reduced.
What types of conditions is this method used for?
The proning method is mainly used for people with severe respiratory diseases who are in a state of ``Hypoxia`` where the body does not receive enough oxygen. However, this method is most commonly used in a condition called Acute Respiratory Distress Syndrome (ARDS) .
Simply put, ARDS is a condition in which the tiny air sacs (alveoli) in our lungs fill with fluid. This makes it very difficult to breathe. ARDS is a serious complication of severe respiratory illnesses like pneumonia and COVID-19.
Why do oxygen levels increase when you turn your head?
The reason for this is very interesting. The main reason for this is that our bodies are not completely symmetrical. Proning mainly does two things.
1. Reduced weight and pressure on the lungs
Think about it, because our bodies are designed to have more lung tissue on the outside than the inside of our chest. When we sleep on our backs, the weight of our heart and other abdominal organs falls directly on our lungs. Also, the fluid that accumulates in our lungs presses down on the air sacs on the outside due to gravity. This reduces the space for the lungs to fill completely with air.
It's like a sponge with a weight on it. When you take the weight off, it swells up nicely, right? That's what's happening here too.
But when we turn a patient from face down, the weight of the heart and abdominal organs moves away from the lungs and towards the chest. Then, the back side, which has more lung tissue, is freed up. So the lungs expand better and can take in more air.
2. Gas Exchange is efficient
In ARDS, there is a mismatch between the amount of oxygen entering the lungs (ventilation) and the amount of oxygen being absorbed into the blood (perfusion). Regardless of our body position, the back of the lungs receives the most blood supply.
Now look, when we turn the patient face down, we are allowing more air to enter the lungs on one side. On the other side, we are directing that oxygen to the part of the lung that has the most blood supply . This makes the breathing process much more efficient. Simply put, this method allows us to send oxygen to where it is needed most.
How do you turn a patient face down?
This is not something that one or two people can do. This is a well-planned team effort. A respiratory therapist, doctors, and nursing staff, at least 5-6 people, work together to do this.
The first step is to secure all the tubes and wires connected to the patient’s body (e.g., breathing tube, saline tube, EKG) so that they cannot come loose. The respiratory therapist carefully holds the patient’s neck and breathing tube. Then, at the same time, according to the same command, the entire team very carefully turns the patient on his or her side, using pillows and cloths. All of this is done to avoid any harm to the patient.
Typically, a patient is placed in this position for between 12 and 18 hours. Often, at least 16 hours are spent in one session, with the patient lying face down and then turned upside down.
| Advantages of the Proning method | Simple explanation |
|---|---|
| Increased oxygen levels | More air enters the lungs and oxygen is absorbed into the blood more efficiently. |
| Easier removal of mucus | Gravity helps mucus and other fluids that accumulate in the lungs to drain easily. |
| Improved heart function | The blood vessels in the lungs open up, making it easier for the heart to pump blood. |
| Decreasing mortality rate | Studies have proven that it significantly reduces the mortality rate in ARDS patients. |
Are there any risks to this method?
As with any medical treatment, there are some risks involved in this procedure. However, these risks can be minimized by having an experienced medical team closely monitor these factors.
- Accidental removal of endotracheal tube
- Loss of venous catheter (such as saline):
- Problems with blood pressure or heart rate: (`Hemodynamic Instability`, `Arrhythmia`)
- Temporary drop in oxygen levels
- Airway obstruction
These risks are very low in hospitals with more than 5 years of experience with the Proning method.
Remember, Proning is a scientifically proven, life-saving treatment for patients battling severe respiratory conditions.
In some cases, patients with mild respiratory distress are advised by their doctor to lie face down (`Awake Proning`). This may prevent them from needing a ventilator.
Take-Home Message
- Proning is the treatment of a patient with severe respiratory distress by turning them face down.
- This reduces pressure on the lungs and helps the body get more oxygen.
- This is a life-saving treatment, mainly used for severe conditions such as ARDS (Acute Respiratory Distress Syndrome) .
- This is done very carefully, by a team of trained doctors.
- If you see your loved one receiving this type of treatment in a hospital, understand that it is a very important step in their recovery. If you have any concerns, talk to the doctor in charge about it.
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