Lying face down improves breathing in severe cases

In order to fight novel coronavirus (COVID-19) pandemic, which has killed more than 16,000 people globally, Chinese researchers have found that lying face down is beneficial and improves breathing in severe cases of COVID-19.

The study, published in the American Journal of Respiratory and Critical Care Medicine, revealed that lying face down was better for the lungs in patients with severe COVID-19 (SARS-CoV-2) hospitalised on ventilators.

"This study is the first description of the behaviour of the lungs in patients with severe COVID-19 requiring mechanical ventilation and receiving positive pressure," said study researcher Haibo Qiu from Southeast University in China.

"It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed (facing downward)," Qiu added.

The retrospective study consisted of 12 patients in Wuhan Jinyintan Hospital in China, with severe COVID-19 infection-related acute respiratory distress syndrome (ARDS) who were assisted by mechanical ventilation.

A majority of patients admitted to the ICU with confirmed COVID-19 developed ARDS, the study said.

According to the researchers, the observational study took place during a six-day period the week of February 18.

The clinicians in Wuhan used an index, the Recruitment-to-Inflation ratio, that measures the response of lungs to pressure (lung recruit ability).

According to the findings, the research team developed this index prior to this study.

The 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 recruit ability.

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, the researchers said.

Patients who did not receive prone positioning had poor lung recruit ability, while alternating supine (face upward) and prone positioning was associated with increased lung recruit ability, they added.

"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," said study researcher Chun Pan, Professor with Zhongda Hospital.

"By contrast, the lung improves when the patient is in a prone position. Considering this can be done, it is important for the management of patients with severe COVID-19 requiring mechanical ventilation," Pan added. IANS