Teams of healthcare workers are spending their days flipping seriously ill coronavirus patients onto their stomachs to help them breathe. They say it save lives., Business Insider - Business Insider Singapore
by Yeji Jesse Lee, Business Insider US- Proning, or flipping patients onto their stomachs to help them breathe, has been around for a while, but the tactic has become more common during the coronavirus pandemic.
- Positioning coronavirus patients on their stomachs improves breathing because it helps open up airways in the lungs that are filled with fluids.
- It also helps to put less pressure on the lungs themselves, making it easier for oxygen to travel in.
- Though the concept of getting a person from their back onto their stomach is simple enough, it’s difficult to safely flip a critically ill patient.
- Some hospitals have begun to prone coronavirus patients regularly in the past few months and others have developed ad hoc “proning teams” whose sole duty is to flip patients back and forth all day.
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Some hospitals in the US have established new teams in the midst of the coronavirus pandemic that have been tasked with one very specific duty: flipping patients onto their stomachs (and then back again).
The method, called “proning,” has helped save lives during this pandemic, according to healthcare workers on the frontlines. The specialized teams that perform the task help keep some of the burden off nurses, who would otherwise have to coordinate times to come together to flip a single patient.
COVID-19, the disease caused by the coronavirus, is infamous for how it attacks patients’ lungs. As a huge influx of patients with breathing problems flocked to hospitals in recent months, doctors turned to the longtime method of improving breathing.
When patients with breathing problems are flipped onto their stomachs, it helps open up the airways in the lungs and makes it easier for oxygen to travel in. In some COVID-19 patients, whose lungs may be filled with fluids, being in this position also helps parts of the lungs that have been pushed down by the weight of the fluids.
The idea of proning patients, or flipping them on their stomachs to help them breathe, has been around for a while, according to Colleen Snydeman, director of the Nursing and Patient Care Services Office of Quality and Safety at Massachusetts General Hospital.
Snydeman told Business Insider that as a staff nurse in the 1980s, she proned patients who would benefit from the position, but that the method has “gone in and out of vogue over the years.”
At Massachusetts General Hospital, proning is a method that was in use before the pandemic, for example on patients in operating rooms, and hospitals have long used the method to treat patients with acute respiratory distress syndrome (ARDS).
A 2013 study in the New England Journal of Medicine showed that patients with ARDS who were proned showed much higher chances of survival than patients who stayed on their backs.
Snydeman says that healthcare workers in countries like Italy and China that were hit earlier by the coronavirus than the US also reported the benefits of proning patients with COVID-19.
Creating enough proning teams to meet the surge of COVID-19 patients coming in is like ‘flying a plane without really learning how to do it in flight’
When hospitals in the US became inundated with COVID-19 patients with breathing complications, proning became a straightforward way to improve survival rates in patients on ventilators, and a way to keep less sick patients off the machine altogether.
The issue with proning is that it requires a lot of hands: at least four individuals have to be ready and around the patient in order to flip them properly without causing complications or further damage to physically weak patients.
“It was something that was being done, but definitely not at the rate that it’s been done now with COVID-19 patients,” Snydeman said.
This has led some hospitals, like Massachusetts General Hospital, to develop and train “proning teams” who go around the hospital in groups of four flipping patients onto their stomachs, and then back again.
Karen Miguel, a registered nurse at Massachusetts General Hospital’s Patient Care Services department is one of the leads on the hospital’s new proning program. She told Business Insider that setting up and organizing the team of nurses, operating room assistants, and physical therapists to prone patients day in and day out was like “flying a plane without really learning how to do it in flight” because of how quickly things had to move and change amid circumstances.
“This was, try things and if it didn’t work in real-time, change it,” said Miguel who helped recruit, train, and dispatch dozens of healthcare workers for teams who would be on watch 24/7 for patients who needed to be flipped onto their stomachs.
The process of flipping a patient is similar to making a bed while a patient is in it, said Miguel, which is a common practice for nurses caring for patients unable to move easily.
After disconnecting all the wires and tubes that can be safely removed for a minute or two, the patient is carefully moved away from their ventilator and then turned on their side. Sheets are placed underneath their body to help the transition.
Then they’re placed on their stomachs as the dirty sheets slide through and the clean sheets are placed under the patient, along with things like pillows that help position thems comfortably. Afterward, every wire and tube is placed back where it’s supposed to be.
The process may sound simple enough, but any slight movement can cause a patient to become unstable, especially because those on ventilators tend to be in critical condition. The flip itself can be nerve-wracking, especially at first.
“It’s a pretty intense time for the staff,” Miguel said. “There’s always an anxiety when you’re not good at something. You’re always worried that you’re going to miss something.”
But the good part of being on a team, Miguel says, is that there are eight eyes on the patient at all times as they’re being flipped, meaning there’s no shortage of people giving feedback and making sure things are going smoothly.
Flipping COVID-19 patients is especially difficult because they’re often “the sickest of the sick”
Cooper Health, in New Jersey, is relying on proning teams to help care for the influx of patients. The teams include CRNAs, EMTs, physical therapists, and other workers.
The act of proning a patient is much harder to do than it might seem because the patients tend to be very sick.
“It’s a challenging job because of the meticulous care and caution that needs to be done when you’re turning these patients who are among the most fragile,” said Dr. Stephen Trzeciak, chief of medicine at Cooper University Health Care. “They’re just barely clinging to life and you have to be very careful as you do that.”
And it’s not just critical patients on ventilators that are being proned in hospitals.
Dr. Mangala Narasimhan, regional director for critical care at Northwell Health in New York, has been helping her hospital’s coordination of critical care for COVID-19 patients. Narasimhan estimates that around a quarter of the hospitalized coronavirus patients in Northwell’s hospitals are being regularly proned and supinated.
And though more data needs to be collected, she and her colleagues are seeing huge differences in oxygenation levels across patients in all 12 of the acute care hospitals in the Northwell system.
Northwell has been proning ventilated patients for years now, but the novel coronavirus has encouraged the hospital to try the method on less sick patients, who are benefiting as well.
“They’ve been doing great,” Narasimhan said. “It’s been keeping some people off the ventilators. It definitely helps with oxygenation and it helps with breathing and we think that it’s really been a good thing.”