Flipping COVID-19 Patients onto Their Stomachs Can Keep Them Alive in Intensive Care

A new study of patients with severe COVID-19 (SARS-CoV-2) hospitalized on ventilators has found that lying face down was better for the lungs. In fact, a 2013 study had also found that the prone position helped lower mortality rates for patients with severe acute respiratory distress syndrome (ARDS). This is a type of respiratory failure caused by inflammation in the lungs that is being experienced by patients with severe COVID-19. According to media reports, COVID-19 patients are now being flipped onto their stomachs, or “prone positioning,” by US healthcare workers as an effective way to keep them alive in intensive care. Placing patients on their front helps them to get the much needed oxygen into their lungs. As part of clinical trials, US researchers are now also studying the effects of turning patients who need extra oxygen on their stomachs.

In the new observational study conducted at a hospital in Wuhan, China, the epicenter of the global pandemic, the researchers studied the treatment of 12 patients with severe COVID-19 infection-related ARDS who were assisted by mechanical ventilation. The researchers used an index, the Recruitment-to-Inflation ratio, that measures the response of lungs to pressure (lung recruitability), and assessed the effect of body positioning. Prone positioning was performed for 24-hour periods in which patients had persistently low levels of blood oxygenation. Oxygen flow, lung volume and airway pressure were measured by devices on patients' ventilators. Other measurements were taken, including the aeration of their airway passages and calculations were done to measure recruitability.

Seven patients received at least one session of prone positioning. Three patients received both prone positioning and ECMO (life support, replacing the function of heart and lungs), while three patients died. The patients who did not receive prone positioning had poor lung recruitability, while alternating supine (face upward) and prone positioning was associated with increased lung recruitability.

"It is only a small number of patients, but our study shows that many patients did not re-open their lungs under high positive pressure and may be exposed to more harm than benefit in trying to increase the pressure," said Chun Pan, MD, study co-author and a professor with Zhongda Hospital, School of Medicine, Southeast University. "By contrast, the lung improves when the patient is in the prone position. Considering this can be done, it is important for the management of patients with severe COVID-19 requiring mechanical ventilation."