TORONTO -- A new review of observational studies suggests that a technique known as prone positioning may help COVID-19 patients who are struggling to breathe but not yet on a ventilator.
Prone positioning has been used for decades in critical care for patients on ventilators with severe acute respiratory distress syndrome, but several observational studies suggest that the technique may also improve oxygenation among COVID-19 patients not yet receiving mechanical ventilation.
"Since the COVID-19 pandemic has overwhelmed some health systems around the globe, leading to intensive care resources becoming strained, prone positioning for patients who are breathing spontaneously and not intubated is an attractive intervention," the study said.
The findings were published Wednesday in the Canadian Medical Association Journal (CMAJ).
Prone positioning refers to placing patients face down on the chest and abdomen to relieve pressure on the lungs. Most of the lung tissue is along the back, not in the front, so placing someone on their belly helps the blood flow to more areas of the lung.
This technique can also help prevent a patient’s lungs from collapsing, health experts say.
COVID-19 can cause fluid to accumulate in the lungs, causing shortness of breath and patients to take smaller breaths. Difficulty breathing and pneumonia in both lungs are among the most common symptoms of the disease, and in the most severe cases, patients need to be intubated.
The review says the use of prone positioning may forgo the need for a ventilator in some cases, however, its authors caution that more research is needed.
Dr. Kevin Venus of Toronto’s University Health Network said in a press release that health experts need "high-quality evidence" that the benefits of prone positioning outweigh the potential cost increase.
He explained that more health-care workers may be needed to flip a COVID-19 patient onto their stomach, resulting in an increased use of personal protective equipment.
"On the other hand, if prone positioning is shown in future studies to decrease admissions to critical care units, this would translate into significant cost savings," Venus added.
The review said prone positioning of patients with COVID-19 in medical wards may become a more common practice in an effort to prevent mechanical ventilation if critical care resources become overwhelmed.
The review's authors say this points to an increased need for hospitals to provide training on proper prone positioning.
"As modelling studies have indicated this may be a risk for Canadian hospitals if public interventions are not followed, hospitals should therefore develop or adopt guidance on prone positioning and support rapid knowledge translation and training of clinical staff," the study said.
While prone positioning may be worth doing for someone struggling to breathe, infectious disease specialist Dr. Abdu Sharkawy previously said it is unlikely that the practice would have a meaningful impact in changing how COVID-19 develops in a patient.
"It's unlikely this will mean the difference between surviving COVID-19 or not. If you get a ‘bad strain’ and you require ventilator support, this would not help prevent it in any way," Sharkawy said in an email to CTVNews.ca.
Sharkawy stressed that prone positioning is not a cure for the novel coronavirus and said those who are having difficulty breathing should seek medical help immediately.
With files from CTVNews.ca's Solarina Ho
