How Does Proning Help COVID Patients?

As most of us in healthcare know, lying prone is lying on your belly. And proning is known to improve oxygenation in patients with COVID pneumonia. So, how does proning improve oxygenation? Here is what to know. 

Proning has been used as a treatment for ARDS since the 1970s. Since then, there are many studies showing the benefits of proning for ARDS. So, it is expected that the same theory explaining how this works is also true for severe COVID pneumonia. 

The theory explaining how this works is a simple one. People have more lung tissue on the backside at the back of their lungs. COVID pneumonia causes fluid to fill some of the alveoli. When a patient is lying supine, gravity pulls this fluid to the backside of their lungs. And this makes it so lung tissue in the back of the lungs does not participate in ventilation. This results in poor perfusion of oxygen into the alveoli and to blood vessels. 

If oxygen levels remain low, proving seems to help here. It helps because gravity pulls fluid from the back of their lungs to the front. And this allows lung tissue in the back of the lungs to participate in ventilation. And this has been shown by studies to improve oxygenation. In the non-ventilation patient, this may prevent the need for intubation and mechanical ventilation. 

This increases the amount of oxygen inhaled that gets into the alveoli and into the bloodstream. And this improves oxygenation. 

At the present time, there are few studies on the effects of proning for COVID pneumonia. That it works is based on personal accounts as opposed to facts obtained by studies. And, of course, it's based on the theory noted above created to explain how proning works for ARDS. Further studies may show something different. 

References. 

1. "Proning During COVID-19," Penn Medicine, https://www.pennmedicine.org/updates/blogs/penn-physician-blog/2020/may/proning-during-covid19, accessed12/11/2021
2. Gillespie,  Claire, "'Proning' is a promising treatment for coronavirus -- here's how it works," Health, 2020, April 21, https://www.health.com/condition/infectious-diseases/coronavirus/proning-treatment-coronavirus, accessed 12/11/2021
3. Khan, et al., "Awake proning: A necessary evil during the COVID-19 Pandemic," Cureus, 2020, July, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402434/, accessed 12/11/2021