Movement is also important to help prevent congestion and keep the lungs inflated, for example post-op care for thoracotomy patients (where the chest wall has been opened which collapses the lung) is mainly about mobilisation—getting out of bed and walking around as soon as possible.
On TWiV 595 they did an interview with a doctor who said he’d been able to get the survival rate of intubated patients up to 50% by using proning, though I don’t recall them going into the details.
Supine positioning is the easiest position for intubation but once the endotracheal tube is in-situ it makes physiological sense to turn the patient over if possible. Assuming the tube is secured in place—which it should be.
Main issues with a prone intubated patient are medical staff accessing/assessing/maintaining the tube—requiring suitable facilities or having to kneel on the floor!
Some patients, by taking oxygen and rolling onto their sides or on their bellies, have quickly returned to normal levels. The tactic is called proning.
[...]
At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.
No one knows yet if this will be a lasting remedy, Dr. Caputo said, but if he could go back to early March, he would advise himself and others: “Don’t jump to intubation.”
[...]
Dr. Josh Farkas, who specializes in pulmonary and critical care medicine at the University of Vermont, said the risks of proning were low. “This is a simple technique which is safe and fairly easy to do,” Dr. Farkas said. “I started doing this some years ago in occasional patients, but never imagined that it would become this widespread and useful.”
Some general comments.
Positioning affects lung capacity and function.
Images (figure 1) and information to see the effects of gravity and compression of the lungs here and here.
Definitions:
supine ~ “facing up”
prone ~ “facing down”
More info: prone-ventilation-for-adult-patients-with-acute-respiratory-distress-syndrome
Proning the non-intubated patient
Movement is also important to help prevent congestion and keep the lungs inflated, for example post-op care for thoracotomy patients (where the chest wall has been opened which collapses the lung) is mainly about mobilisation—getting out of bed and walking around as soon as possible.
So yes, definitely worth a closer look.
On TWiV 595 they did an interview with a doctor who said he’d been able to get the survival rate of intubated patients up to 50% by using proning, though I don’t recall them going into the details.
Supine positioning is the easiest position for intubation but once the endotracheal tube is in-situ it makes physiological sense to turn the patient over if possible. Assuming the tube is secured in place—which it should be.
Main issues with a prone intubated patient are medical staff accessing/assessing/maintaining the tube—requiring suitable facilities or having to kneel on the floor!
Supine and immobile for days—not good.
Some more on proning in this NYT article: