Covid-19 | Proning What is proning? Proning a medically approved position — which is also being promoted by the Union Ministry of Health and Family Welfare — in which patients are made to lie on their abdomen to boost their oxygen levels. Proning has its immediate benefits, as in the recent case of an 82-year-old Covid positive patient from Gorakhpur, whose oxygen levels improved from 75 to 94 after sleeping in a prone position, as per a news report published in an English daily. Proning as an exercise is being advised to Covid patients in hospitals, so that they may not require additional oxygen support. Covid-19: Urvish Patel creates awareness on ‘how to get your oxygen levels up’ The alarming spike in Covid-19 cases across India and the crashing healthcare system with shortage of oxygen cylinders, hospital beds, medicines and other medical facilities has left people desperate and in this crisis. Recently, Urvish Patel, Meh, Gujarat created awareness on “how to get your oxygen levels up” when no oxygen cylinders were around. Don’t have access to oxygen cylinders when SpO2 level drops below 94? Here’s what to do: In the year 1976, Dr Robert Brown and nurse Margaret Piehl had co-authored a paper. In the paper, they mentioned that proning helps patients suffering from deadly fluid build-up in their lungs. After this, proning was practised all over the world in patients suffering from respiratory distress. As the COVID-19 pandemic primarily affects the lungs, proning is also advised in COVID-19 patients suffering from respiratory problems. Self- Proning For Coronavirus Proning means lying the patient with the face down. It provides relief to the patient suffering from respiratory distress. The procedure was done long back in the patients suffering from Acute Respiratory Distress Syndrome (ARDS). Various studies have concluded that early initiation of proning in patients with ARDS results in reduced mortality. Because of the respiratory system involvement in the current COVID-19 pandemic and reduced availability of medical care and oxygen beds, the importance of self-proning is revisited by several studies. Many of them revealed that the process is also effective in improving oxygen saturation in COVID-19 patients. The recent guidelines of the Ministry of Health and Family Welfare encourage proning at home in COVID-19 patients with respiratory issues. Advantages Of Self-Proning At Home Buys time for medical help: Medical help is required in severe cases of respiratory distress. However, by the time medical help arrives, there must be a continuous supply of oxygen. Proning improves the level of oxygen saturation. Improves oxygen saturation: In people with a moderate dip in oxygen levels, proning improves their oxygen saturation. Relieves respiratory symptoms: Proning also helps in improving respiratory symptoms. It includes shortness of breath and low oxygenation. Reduced requirement of supplemental oxygen: Proning reduces the need for supplemental oxygen. A study concludes that self-prone positioning in patients with COVID-19 pneumonia reduces external oxygen demand. Reduces the need for ventilator support: Proning improves pulmonary ventilation and helps in keeping the alveoli open. It also prevents or reduces the build-up of fluid in the lungs. It may lower the requirement of a ventilator. Self-proning is a highly effective procedure. It should be done through correct steps to attain maximum benefit. Self-proning guidelines are as follows: Position 1: Lying on your belly for 30 minutes with your head below body level and a pillow under your neck bone. Keep another pillow below your pelvis area in a way that your belly should be free enough to let one hand pass from below and place yet another pillow under your feet. Position 2: Lying on your right side for 30 minutes with a pillow under your head. Tuck another pillow under your waist and yet another pillow between your legs. Position 3: Sitting up for 30 minutes and resting in a slanted position. Keep switching between these 3 positions every 30 minutes. Make yourself as comfortable as possible. Keep room well ventilated and try breathing as much fresh air as possible. Self-proning is a simple and effective process for improving blood oxygen levels. The procedure is found to be effective in COVID-19 patients. Proning improves ventilation and reduces respiratory symptoms. It also helps in preventing fluid build-up in the lungs. Who should not do proning? 1) Avoid proning after eating food. 2) Pregnant ladies should not do proning. 3) If you are suffering from a pelvic fracture or have any disease related to the spine, proning may worsen your condition. 4) People with severe cardiac conditions should avoid doing proning. 5) Patients suffering from deep vein thrombosis should not do proning. How effective is self-proning in patients with COVID-19? Several studies have shown various benefits of self-proning in Covid-19 patients. There is an improved oxygen saturation after proning in COVID-19 patients. The oxygen requirement is reduced and the patients have a low risk of getting on ventilator support. It also helps in preventing the worsening of respiratory symptoms such as hypoxia or dyspnea. How self-proning improves oxygen level? Yes, Self-proning improves oxygen level through various mechanisms. It improves ventilation and redistributes blood flow. Proning reduces lung compression and promotes secretion clearance. It also manages ventilation/perfusion (V/Q) mismatch and improves oxygenation.