SoCal ER creates protocol for prone position treatment, which may help treat COVID-19 patients

Doctors are seeing unusual success with a decidedly low-tech technique to treat those with novel coronavirus. Locally, Providence St. Joseph Medical Center has created a protocol for the prone position, turning patients on their stomachs and sides.
What helps many COVID-19 patients become success stories? White House Coronavirus Task Force Coordinator Dr. Deborah Birx said, "We of course have improved treatment in the hospitals that we didn't have in March or April."

Back then, the focus was on ventilators or rather the lack of them. Now with high-tech ways to oxygenate patients and new medications, a lot has changed. But, a new report finds one low-tech strategy applied early on may be key to a patient's survival.

"This is the proning position. So, you're going to do this for about 30 minutes to an hour," said emergency medicine physician Dr. Michael Daignault. "The pillows are used on all the dependent areas of the body to make the patient as horizontal as possible."
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Daignault said doctors started trying this in places like New York and Italy where there weren't enough ventilators.

"It really took a lot of bravery and innovation to step back and say hey let's rethink this," he said.

Daignault and his colleagues at Providence St. Joseph Medical Center have even created their own protocol for turning patients into the prone position.

He said, "We see dramatic improvements in oxygen saturation within minutes."

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Daignault said it works because of the lungs' anatomy. When you're on your back the largest portions of your lungs are compressed.

"So, you're really not maximally using your lung capacity," he said.

Although promising, researchers note not all patients tolerated the prone position and nearly half in the study eventually required intubation. But going forward, Daignault sees this as an important part of treating COVID-19 patients.

He said, "Even when I don't have a positive test already and the patient can work with us and work with the nursing staff, we start proning them immediately."

One concern in using the prone position in patients who can breathe on their own is that it may delay intubation and mechanical ventilation. But when is the right time to put a patient on a ventilator? Doctors said that needs more study.

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