17 Apr Necessity is the Mother of Invention
Prone ventilation, or proning, has been around since the late 1990’s, but has come to the forefront recently due to the coronavirus pandemic. Historically, prone ventilation was used in only the most extreme cases. Patients who were not able to maintain proper oxygen levels on the ventilator would be turned onto their stomach in effort to assist ventilation and perfusion.
If you look at this diagram you can see that the heart and intrathoracic structures occupy a significant area in the supine (lying face upward) position, demonstrating that the lungs are not symmetrical. And the areas of lung that lie more dependent are more difficult to ventilate. The purpose of proning is to get patients off their backs and make more lung tissue available for oxygen exchange.
So why has proning become the buzzword of the ER’s and ICU’s hit hardest by COVID19? Because doctors were placed in a predicament of not having adequate numbers of ventilators. Instead of quickly sedating people who had low levels of oxygen and then putting them on mechanical ventilation, doctors had to improvise. They are now having the conscious patient roll over in bed on their own, breathing on their own. Surprisingly, many patients have done remarkably well, bringing their oxygen levels back to normal. And no ventilator means less trauma to the lungs and potentially quicker recovery.
So the long standing paradigms of medicine are now being challenged. It is too early to know, but quite possibly, the coronavirus pandemic may yield better ways to care for our patients.