Proning may be promising treatment for COVID-19 patients

Medical Watch
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While communities across the nation shift focus to racial injustice, inside hospitals, the mission to help those fighting COVID-19 continues. And those on the frontlines of the healthcare crisis say they’ve mastered critical new techniques to help their patients.

In the early days of the pandemic, the go-to device was the mechanical ventilator. There were fears of a shortage as doctors around the world witnessed COVID-19 patients decline quickly. But the intervention is risky.

“We’ve known for a long time when you put people on vents the act of providing pressurized air into the lungs can cause some damage to the lungs it’s something called ventilator associated lung injury,” Dr. Ravi Nemivant, DuPage Medical Group pulmonary and critical care physician, Said.

“This was probably such a highly inflammatory condition that while it led to the need for a great amount of oxygen actually putting them on vents probably precipitated even more damage to the lungs that were already in a fragile and inflamed state, and that probably led to very high mortality rates 75 to 80 percent once they got on ventilators,” Nemivant said.

That’s when proning emerged as a strategy to help patients struggling to breathe. It takes a team to execute the complex maneuver.

“You can see that it’s not simple at the head of the bed is a resp therapist who has to secure the airway and the connection to the ventilator while they are actually flipping the patient over and that usually requires about six nurses three on each side nurses and patient care technicians to actually perform the physical act of proning,” Nemivant said.

The technique has been around long before COVID-19. It’s most commonly used to help patients with lung disease improve blood-oxygen levels. It works for those on and off a ventilator.

“It’s a complex physiology but there seems to be something to do with stabilizing the chest wall and being able to recruit more lung volume that enables oxygen levels to improve,” Nemivant said.

DuPage Medical Group’s Nemivant says patients can be placed in the proning position up to 16 hours a day depending on how sick they are.

“As a medical community we have a much better approach to this illness now than we had 12 weeks ago. Twelve weeks ago, it took us all by storm. It was dramatic and it was scary,” he said.

“And now we’ve learned so much about not just what works against the virus what doesn’t work against the virus, but we’ve learned a lot about our own capabilities to take care of these patients,” Nemivant said.

COVID-19 cases are down 20% to 25% in Nemivant’s practice. And he says his patients who are able to tolerate proning appear to have better survival rates.

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