By John Irvine – Registered Nurse, ICU, UK EMT in Lebanon
‘Experience has shown that it is such an important part of COVID-19 case management, that we are not only using it in intensive care but advising and encouraging awake patients to lie in the prone position.’
John Irvine is an ICU nurse and UK-Med register member from Boness, near Glasgow. John first deployed as part of the UK Emergency Medical Team (UK EMT) in Lebanon in September 2020 for nearly two and a half months. Following a short break, he returned in January 2021 and continued to train health care teams in the management of critically ill patients with COVID-19.
What is proning and how does it work?
Very simply put: proning a patient means putting a patient into the prone position – flat on their belly with their chest and face down – rather than on their back. The aim of doing this is to try and help them breathe more easily.
One reason that proning is effective is that the human body has a large volume of lung tissue towards the back of the body. By lying on your back for long periods of time, these areas can become compressed.
When patients are ill with some types of respiratory problems, including coronavirus, the lung can produce abnormal fluids and secretions that will pool by gravity in the lower parts of the lungs. Changing the patient’s position opens up different areas of the lung and can assist in moving the pooled secretions.
Even as a healthy person, if you laid in bed for two weeks on your back without moving, you could potentially end up with lung problems. For an ill patient with COVID-19 who is already suffering from breathing problems, this is much more serious and exacerbates their condition.
What are the benefits of proning?
Proning a patient allows their lungs to open up again and improves the flow of oxygen. It is an established and evidence-based procedure that has been used in ICU with sick patients to help their respiratory function.
Experience has shown that it is such a critical part of COVID-19 case management that, on top of using it in intensive care, we are also advising and encouraging awake patients to lie in the prone position too.
Positioning patients and getting them to move, or moving them if they are unable, is important in ICU patient care more generally. Lying in bed for prolonged periods can slow a patient’s recovery and causes many different problems, including atrophied muscles and painful pressure sores. So, we always encourage people to sit up and move around as much as they can to help their recovery.
A simple but often under-used technique
However, proning and patient positioning are not always commonly understood or practised, so the UK-EMT nursing team have been providing a lot of training and guidance to local staff. We have used clinical coaching to demonstrate the correct technique which has been a success. Hospital staff have been able to see the immediate improvements in a patient’s condition after we’ve helped them to prone, which in turn has helped to build the staff’s confidence and skills.
Proning does not require any specialist equipment – all that is needed is some extra pillows to help position the patient. This makes it an excellent strategy to improve patient’s outcomes in low resource countries.
UK-Med, as part of the UK Emergency Medical Team (UK EMT), have been working in Lebanon since August 2020, following the huge explosion that ripped through Beirut’s port. Since then, the team have supported six public hospitals across the country, where they have focussed their support on COVID-19 intensive care units, COVID-19 wards and emergency departments.
John and the team have been working with hospital staff to increase their skills, capacity and confidence in managing coronavirus cases, including teaching techniques like proning, and to help improve patient and staff safety. Read more about UK-Med’s response in Lebanon.