NEW YORK, N.Y. (Ivanhoe Newswire)— It’s one of the lessons from the hospital frontlines and it was reinforced during the recent coronavirus pandemic— positioning matters. A significant percentage of COVID pneumonia patients who were placed on their stomachs or sides early on, were able to avoid mechanical ventilation.
As patients began to flood hospitals in March and April, ventilators were in short supply. That’s when some emergency doctors began to rethink patients’ positions in bed. Traditionally, on their backs.
Nicholas Caputo, MD, MSc, FACEP, FAAEM, MAJ, associate chief and attending physician in the department of emergency medicine at NYC Health and Hospitals explained, “Just by the weight of your media sternum, your heart and your chest on the lungs, it collapses some of the spaces of the lungs. You turn the patients over, and what that does is that helps to open up some of the collapsed alveoli.”
Airway specialist Dr. Richard Levitan volunteered at a New York hospital for ten days and saw the benefits and the drawbacks of being awake in a prone position.
“Patients sometimes are uncomfortable laying down on their stomach. And I came up with the idea to use a pregnancy massage cushion as a way to help patients lay on their stomach comfortably,” Dr. Levitan recalled.
Dr. Levitan coordinated with a California company that made proning boosters and had some distributed to several New York hospitals. At the same time, Levitan and Dr. Caputo did a small study following 50 COVID patients who were placed in a prone position at one hospital in the Bronx.
“And in those 50 patients within the first 24 hours we were able to avoid intubation in three quarters of them.”
A small change in position making a life-altering difference in some COVID patients.
Dr. Levitan has since formed the non-profit Prone2Help which distributes the proning mattresses to hospitals. To date, Prone2Help has distributed more than 650 proning cushions to more than 200 hospitals in 45 states.
Contributors to this news report include: Cyndy McGrath, Executive & Field Producer; Roque Correa, Editor.
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MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: PRONING: FACE DOWN TO FIGHT COVID PNEUMONIA
REPORT: MB #4761
COVID-19 BACKGROUND: Coronaviruses are a large group of viruses that can cause illness in animals and humans. Some coronaviruses commonly circulate in the United States and usually cause upper respiratory symptoms such as cough or runny nose, although some can cause more serious illness. COVID-19 is a disease that was identified in Wuhan, China, and is now being spread throughout the world. As of June 8, 2020, there are 1.9 million total cases and 110,375 deaths in the U.S. COVID-19 is caused by a coronavirus called SARS-CoV-2. Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. It is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet). It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.
Sources: https://dph.georgia.gov/what-covid-19; https://www.cdc.gov/coronavirus)
WHAT COVID-19 DOES TO THE LUNGS: COVID-19 can cause lasting lung damage. It can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs. In pneumonia, the lungs become filled with fluid and inflamed, leading to breathing difficulties. For some people, breathing problems can become severe enough to require treatment at the hospital with oxygen or even a ventilator. The pneumonia that COVID-19 causes tends to take hold in both lungs. Air sacs in the lungs fill with fluid, limiting their ability to take in oxygen and causing shortness of breath, cough and other symptoms. While most people recover from pneumonia without any lasting lung damage, the pneumonia associated with COVID-19 may be severe. Even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve. As COVID-19 pneumonia progresses, more of the air sacs become filled with fluid leaking from the tiny blood vessels in the lungs. Eventually, shortness of breath sets in, and can lead to acute respiratory distress syndrome (ARDS), a form of lung failure. Patients with ARDS are often unable to breath on their own and may require ventilator support to help circulate oxygen in the body. Whether it occurs at home or at the hospital, ARDS can be fatal. People who survive ARDS and recover from COVID-19 may have lasting pulmonary scarring. There are three factors that affect the lung damage risk in COVID-19 infections and how likely the person is to recover and regain lung function – Disease severity, health conditions and treatment. Mechanical ventilation always comes with risks: a tube must be placed into a patient’s airway to deliver oxygen to their body when their lungs no longer can. It’s an invasive form of support, and most doctors view it as a last resort. Under the best of circumstances, up to half of patients sick enough to require this type of ventilation won’t make it. But for COVID-19, the numbers are even worse. Only a small portion of COVID-19 patients get sick enough to require ventilation—but for the unlucky few who do, data out of China and New York City suggest upwards of 80% do not recover.
(Sources: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs; https://time.com/5820556/ventilators-covid-19/)
NEW TECHNOLOGY: It has been shown that the prone position (PP) during mechanical ventilation in patients with Acute Respiratory Distress Syndrome (ARDS) is able to improve oxygenation and thus reduce mortality. The reduced mortality, however, is not only caused by an increase in oxygen, but also by the ability of the PP to reduce the damage associated with mechanical ventilation. Studies also show that the benefits of PP are also present in non-intubated patients; the PP prevents the need for intubation and the consequent risk deriving from the procedure itself and from the predisposition to develop superinfections. So, it presents a reduction in the need for intubation and therefore hospitalization in the ICU which would be particularly useful in great health emergencies with limited resources. Dr. Richard Levitan an airway specialist who has practiced emergency medicine for over 30 years and his brothers Robert and Dan found Prone2help.org. It gives free proning support cushions to healthcare workers which gives them a practical innovation to help COVID-19 patients breathe. Proning or resting a patient on their stomach opens the lungs to facilitate breathing. Proning support cushions can significantly increase comfort. It allows larger bodied patients to comfortably prone, allows use of oxygenation devices, it has a standard width so it easily fits stretchers and hospital beds and can be easily cleaned.
(Source: https://www.prone2help.org/; https://clinicaltrials.gov/ct2/show/NCT04365959)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
AIRWAY CAM
NICHOLAS CAPUTO
DEPARTMENT OF EMERGENCY MEDICINE
LINCOLN MEDICAL AND MENTAL HEALTH CENTER
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