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In an interview with BW Businessworld, Dr Rajesh Kumar Pande, Senior Director & HOD, BLK – Max Centre for Critical Care, BLK-Max Super Speciality Hospital, explains how prone position work in increasing oxygen level.
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What is a prone position?
It is a simple technique that requires patients to lie on their belly with chest and face down. Flipping the patient in the prone position helps respiration by improving oxygen supply in the blood.
How does the prone position work in increasing oxygen level?
When we are in supine position or lie down horizontally with the face and torso facing up, the heart falls on the lungs as it is above the lungs. As a result of which the heart presses the lungs and a significant part of the lungs is unable to completely expand or fully inflate. But, when we sleep in the face down (on stomach), the weight of the heart is supported by our rib cage and the spine. The heart is no longer pressing on the lungs making room for the lungs to completely inflate and function properly. It is very important that the supply of oxygen reaches all parts of the body equally which happens through blood circulation via the perfusion process. In the prone position, the blood circulation, and the oxygen supply both are at an excellent level such that enough blood reaches all parts of the body. The balance between ventilation (flow of air into and out of the lung walls) and perfusion (flow of blood to the lung wall capillaries) is quite good in the prone position.
Can you give us a step-by-step home guide for self proning?
Please do use an oximeter during this whole process to keep measuring the oxygen levels-
• Position 1: Lie down on your belly for 30mins to 2 hours.
If the patient is already on oxygen support, then oxygen should not be removed in this position, turn head to left/right side and continue oxygen support. Place the pillow under the head, chest, and pelvis for support but the abdomen should not be compressed.
• Position 2: Lie on your left side for 30mins to 2 hours.
• Position 3: Sit-up for 30mins to 2 hours.
• Position 4: Lie on your right side for 30mins to 2 hours.
• Position 5: Go back to position 1- lie on your stomach for 30 mins to 2 hours.
Can all patients benefit from prone position?
It differs from person to person which can only be determined by asking the patient to lie in a prone position. For some, the oxygen levels improve greatly but for some, not much difference is visible in oxygen levels, and this is how one can ascertain if this is working for them or not.
Who should avoid proning?
A5- Proning is not advisable for-
• Pregnant women
• Patients with serious cardiac conditions
• Patients with unstable spine or fractured spine
• Patients with pelvic fractures.
Are there any additional dos and don’ts to be kept in mind while self proning?
There are few important things to be kept in mind if you are planning to do self proning at home-
• To be avoided after meals for at least 2 hours
• Only repeat the procedure as many times as easily doable or tolerable. Do not over-exert yourself
• Keep a check on any pressure sores or injuries while proning
• Ensure blood pressure and hydration is maintained during the process.