Covid-19 Clinical Care: New Medical Study Shows That COVID-19 Patients In Severe Conditions Should Lie Face Down To Facilitate Breathing
Covid-19 Clinical Care
: A retrospective study that was conducted by Dr Haibo Qiu and Dr Chun Pan, leading Chinese pulmonologists and co-authors report on a study of the treatment of 12 patients in Wuhan Jinyintan Hospital, who had severe COVID-19 and had related acute respiratory distress syndrome (ARDS) and were assisted by mechanical ventilation, found that having the patients lie face down was better for the lungs and facilitated better breathing.
The study was published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine. (https://www.atsjournals.org/doi/10.1164/rccm.202003-0527LE)
Both Dr Qiu and Dr Pan were in charge of the treatment of these patients, who were transferred from other treatment centers to Jinyintan Hospital in Wuhan.
Almost all patients admitted to the ICU with confirmed COVID-19 developed ARDS.
This new observational study took place during a six-day period the week of Feb. 18, 2020.
Dr Qiu who is Professor at the Department of Critical Care Medicine, Zhangda Hospital, School of Medicine, Southeast University, Nanjing, China told Thailand Medical News, "This study is the first description of the behavior of the lungs in patients with severe COVID-19 requiring mechanical ventilation and receiving positive pressure. It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed (facing downward)."
Both the clinicians who are based in Wuhan used an index, the Recruitment-to-Inflation ratio, that measures the response of lungs to pressure (lung recruitability).
Other members of the research team include Dr Lu Chen, Ph.D., and Dr Laurent Brochard, Ph.D., HDR, from the University of Toronto
Dr Laurent Brochard had developed this index prior to this study.
The medical researchers assessed the effect of body positioning. Prone positioning was performed for 24-hour periods in which patients had persistently low levels of blood oxygenation. Oxygen flow, lung volume and airway pressure were measured by devices on patients' ventilators. Other measurements were taken, including the aeration of their airway passages and calculations were done to measure recruitability.
Of the 12 patients, seven patients received at least one session of prone positioning. Three patients received both prone positioning and ECMO (life support, replacing the function of heart and lungs). Three patients died.
It was observed that patients who did not receive prone positioning had poor lung recruitability, while alternating supine (face upward) and prone positioning was associated with increased lung recruitability.
Dr Chun Pan also a Professor with Zhongda Hospital, School of Medicine, Southeast University commented, "It is only a small number of patients, but our study shows that many patients did not re-open their lungs under high positive pressure and may be exposed to more harm than benefit in trying to increase the pressure. By contrast, the lung improves when the patient is in the prone position. Considering this can be done, it is important for
the management of patients with severe COVID-19 requiring mechanical ventilation."
The research team consisted of scientists and clinicians affiliated with four Chinese and two Canadian hospitals, medical schools and universities.
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