COVID Proning (Jae C. Hong / Associated Press)
Can you imagine what proning is? The term applies to people who cannot breathe. Medical workers change the patient's position in bed so that, hopefully, she can breathe easier.
Proning means that you are being turned from lying in bed on your back, to lying in bed on your stomach. Try that. Find it easier to breath when you lie on your stomach than when you were lying on your back?
Proning works in large part because of gravity. Lying on our stomachs helps most of us by opening airways in our lungs. If we have contracted COVID, natural forces that may be compressing our lungs are enhanced by the compressing effects of fluid and inflammation that come from the infection.
When we human beings lie on our backs, our hearts are now sitting on top of our lungs. Naturally, the lungs compress in that position. Our rib cage cannot move the way it usually does when it is flat against the bed. Flipping over to our stomachs tends to free the back of our lungs to open, allowing our bodies to breathe easier.
Proning takes much hard work. And a lot of hands to do it. Before COVID came, the standard protocol for proning teams sometimes involved as many as 8 workers. Most of the time, workers were experienced and trained in the technique.
Proning teams formed before COVID could have fielded a team under traditional sandlot baseball rules, which provide either that the other team provides the missing player (who plays a position carefully chosen by the short-handed team) or that one of the outfields (usually right field) is out of bounds for play.
The reason for so many hands being involved in proning is what can happen if it is done wrong. It is the product of anxiety, to be frank about it. Care has to be exercised during proning lest a patient's breathing tube come loose during the procedure, or a person's intravenous lines detach while she is being moved from her back to her stomach in her hospital bed.
COVID Proning and Supinating (Hilary Swift / New York Times)
But the rules regarding proning have changed since COVID arrived. There just aren't enough workers. Since the pandemic began, proning teams have sometimes been fielded with only 3 or 4 people.
Another way to look at proning is that before COVID, proning was used for only about 15% of patients diagnosed with acute respiratory-distress syndrome (ARDS) and embedded with breathing tubes accordingly. The technique can result in compressing nerves in limbs including shoulders and legs. This increases the chance of disability.
There is also reportedly a lot of evidence that proning actually decreases the patients' life-spans.
The jury is out on whether proning shortens COVID patients' life-spans, or to what degree proning COVID patients results in disabilities, but in the meantime there may not be any good options but to go ahead and prone the COVID patients. Proning can save our lives today even if we are uncertain what it will do to us tomorrow.
Obviously, proning is a procedure of choice only when there do not seem to be any better alternatives.
In terms of procedures, supinating is the opposite of proning. Like proning, supinating still applies to people who cannot breathe, but the term means something different than proning does. That term, supinating, refers instead to changing a patient's position in bed from lying on her stomach, to lying on her back.
In my case, I prefer to lie on my back. I sleep on my back or on my side in fact. Having tried a few positions on my back and on my side as an experiment for this article, it is easier for me to breathe when I am in those positions. So proning is an extreme measure.
COVID19 ICU Help Turning Sign (Marcus Yam / Los Angeles Times)
So extreme that proning carries with it important protocols. It's used during the coronavirus pandemic because hospitals have never had so many patients at the same time that are so sick that their lungs have essentially stopped functioning. Respiratory distress is the chief sign that the coronavirus is present. At the present time, the anxieties involved with proning patients including the possible after-effects of the procedure, pale in comparison to a patient's inability to breathe because of COVID.
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