RandyAg98 said:

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Based on the other docs and RNs on this board, that seems to be fairly standard practice.

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Only it's typically not tried until the patient is really sick on the vent. I've not seen nasal cannula patients proned. Maybe some pulmonologists here have done that on the regular, but I've only seen it in critically ill already incubated patients.

Has this started to become a thing the last couple years since I've been away from bedside?

Interesting. Seemed to me (as a veterinarian, not an MD or RN or RT) that anyone oxygen-dependent would be proned. That was the impression I got.

My experience is nasal cannula patients are never asked to be in a prone position. It's not something I've ever seen a doctor order and it's not something that our beds on regular patient care floors are made for. Many, many patients we see in the hospital are older, have arthritis or bad backs and have difficulty finding comfortable positions at all. Sometimes the best we can do in terms of position is highly encourage them to sit up in a chair.

In other words, it's a lot easier to prone a vent patient because they aren't going to whine about it.

I absolutely see the physiological benefit. It reduces the pressure on the lungs by the heart and fat tissue and allows more lung tissue to be ventilated. There are some other benefits as well.


For anyone wanting to read about it, here's one paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026253/

Moxley said:

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My experience is nasal cannula patients are never asked to be in a prone position. It's not something I've ever seen a doctor order and it's not something that our beds on regular patient care floors are made for. Many, many patients we see in the hospital are older, have arthritis or bad backs and have difficulty finding comfortable positions at all. Sometimes the best we can do in terms of position is highly encourage them to sit up in a chair.

In other words, it's a lot easier to prone a vent patient because they aren't going to whine about it.

I absolutely see the physiological benefit. It reduces the pressure on the lungs by the heart and fat tissue and allows more lung tissue to be ventilated. There are some other benefits as well.


For anyone wanting to read about it, here's one paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026253/

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I don't dispute that at all and I highly suspect that if it was used more often, we would see a significant uptick in positive outcomes. I was just commenting on the fact that I have never seen it used on anyone who is not extremely sick and vented.

Thank you for posting that link. Very good information for those that aren't as familiar with proning.

A friend of mine who is a nurse and her hubby is a doctor posted a Facebook link about how to do it at home.

I was going to ask if there is benefit with proning a quarantined pt on room air?

The mortality effects of proning in ARDS have shown mixed results. Clearly there is improvements in oxygenation. Includes COVID- 19 pts. Everyone is doing it. Is it saving lives in these pts? I don't think so. But we do what we can. ECMO would be nice. But it doesnt seem practical in cytokine storm when they get multi organ failure.

No one prones patients that are not intubated. People are interested in it because if you're proned while on nasal cannula then perhaps you won't progress to the point of needing intubation, possibly avoiding the ventilator crisis. The hospital I work at is trying it out on some of our COVID positive floor patients, prelim results have not shown it to be beneficial.

The whole purpose of proning is to improve V/Q mismatch for patients who are incredibly hypoxemic. If you're well enough to be at home I don't see how it could help you.

Doctors have posted they have not admitted some double pneumonia patients. Sent them home with O2 nasal cannula orders. I'm sure others with pulse ox sats in the low 90s and difficulty breathing have been sent home, too. Why wouldn't it be beneficial to ask them to prone as much as possible? Am I missing something? I've heard of a lot of sick people that don't even go to the ER. Would proning help them recover at home?

It probably won't hurt you, so in that sense people are free to try it. I'm saying I don't see much of a physiologic basis for it but often in medicine stuff doesn't make sense anyway.

FYI the only published, proven protocols that demonstrate benefit in intubated patients include proning a patient for 12 hrs/day. Most hospitals use a protocol of 16 hrs straight. Unlikely tolerable for someone who is awake and relatively well at home. But I guess it won't hurt to do what you can.