Laying COVID-19 Patients on Their Stomachs Shown to Help Them Breathe

Positioning patients on their stomachs can help alleviate respiratory distress among COVID-19 patients, according to multiple studies.

The technique, which is known as "prone positioning," has been used for years to improve outcomes for intubated patients with Acute Respiratory Distress Syndrome, a leading cause of death among COVID-19 patients. Several studies suggest that the practice may improve outcomes for those infected with the virus.

An observational study published in medical journal The Lancet on June 19 found that the method was "feasible and effective in ameliorating blood oxygenation" for a group of patients in Italy who required supplemental oxygen due to pneumonia related to COVID-19.

Of the 47 patients who were repositioned, 23 continued to experience improved breathing when they were put back into a face-up position. However, those who responded positively to the technique were no less likely to require invasive ventilation as the disease progressed.

A study published days earlier in the journal JAMA Internal Medicine surveyed a small group of patients in New York City who were not undergoing invasive ventilation. It found that out of a majority of patients placed in the prone position for at least one hour saw oxygen saturation levels increase significantly, reducing the chances they would need to be intubated.

"We found that the use of the prone position for awake, spontaneously breathing patients with COVID-19 severe hypoxemic respiratory failure was associated with improved oxygenation," the study's authors wrote, while noting that further studies are warranted to determine if the technique improves survival.

Prone Team Positioning Patient
A "prone team" at the intensive care unit of Stamford Hospital moves a COVID-19 patient onto their stomach in hopes of improving breathing in Stamford, Connecticut on April 24, 2020. Stamford Hospital/Getty

Another small study published by JAMA in May suggested that the technique could have benefit for some patients that are not intubated, although a significant number of patients are unable to tolerate the positioning for long periods.

While researchers have stressed that additional studies, especially those randomized and controlled, are needed to confirm the usefulness of prone positioning, many doctors have been using it for COVID-19 since the outset of the pandemic. Anecdotal accounts given during the height of the pandemic suggested sometimes dramatic results.

"Once you see it work, you want to do it more, and you see it work almost immediately," Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital, told CNN in April. "By putting them on their stomachs, we're opening up parts of the lung that weren't open before."

Professionals from New York City's Mount Sinai hospital, which treated a large number of critically ill patients during the city's unprecedented outbreak, can be seen demonstrating the technique in a video posted online in April.

Physical therapist Sarah Leister, who was involved in the development of Mount Sinai's proning team, told WBAL that it can take an hour for a minimum of five health care workers to turn one patient over, with the typically poor condition of patients presenting further challenges.

"Most of the patients are sedated and paralyzed," Leister told the outlet. "We do our best with these patients; they are so frail. Their skin is paper-thin. We're doing as best we can to add foam and cushions to the patients."

Newsweek reached out to Mount Sinai for comment but did not receive a response in time for publication.