A group of researchers in Wuhan, China, found that patients with severe COVID-19 symptoms lying on their stomachs were better off than those lying on their backs. The study involved observing the effects of lying positions in a small cohort of a dozen patients who were hospitalized on ventilators suffering from severe COVID-19 disease. The research was published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
The team, including Zhongda Hospital’s Professor Chun Pan, Southeast University’s Professor Haibo Qiu, and colleagues, was responsible for the treatment of 12 people with severe COVID-19-related acute respiratory distress syndrome (ARDS). The observational study took place at Wuhan Jinyintan Hospital for six days the week of February 18, 2020.
Professor Qiu said:
This study is the first description of the behavior of the lungs in patients with severe COVID-19 requiring mechanical ventilation and receiving positive pressure. It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed (facing downward).
The Study
- An index called the ‘Recruitment-to-Inflation ratio’ was used to measure the response of lungs to pressure – known as ‘lung recruitability.’
- The clinicians measured every time the patient changed body positioning to assess the effects it had on the body.
- Sessions of prone positioning (lying face down on stomach) were performed for 24-hour stretches.
- Seven of the patients received at least one session.
- Three received both prone positioning and life support (ECMO), which replaced the function of the lungs and heart.
- During these periods, the patients had consistently low levels of blood oxygenation. The researchers knew this because devices on the patients’ ventilators measured lung volume, oxygen flow, and airway pressure.
- Additional measurements were taken – such as aeration of their airway passages – and calculations were made to measure recruitability with all the data.
- Patients who received alternating supine (face upward) and prone (face down) positioning had increased lung recruitability.
- Patients who didn’t lie face down had poor lung recruitability.
- Three of the patients died.
Professor Pan said:
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. By contrast, the lung improves when the patient is in a prone position. Considering this can be done, it is important for the management of patients with severe COVID-19 requiring mechanical ventilation.
The study suggests having patients lie face down for periods to help improve the condition of their lungs.
