SINGAPORE – Patients lying face down on their stomach in hospital beds have needed less oxygen support than those lying on their back, a discovery which has prompted the National Centre for Infectious Diseases (NCID) to place more of its patients in the prone position.

Respiratory and Critical Care Medicine consultant Puah Ser Hon declined to provide specific numbers when speaking to The Straits Times on Thursday (April 23) but said “significantly more” Covid-19 patients at the centre are now lying on their stomach.

Dr Puah, who is with Tan Tock Seng Hospital, looks after patients in NCID’s intensive care unit (ICU).

The 330-bed facility, which was built to strengthen Singapore’s capabilities in infectious disease management and prevention, has had over 1,900 Covid-19 patients since the disease began spreading here on Jan 23. Dr Puah said the NCID made the move after increasing anecdotal evidence showed putting Covid-19 patients in the prone position helps improve their oxygen flow.

“We’re seeing quite a remarkable change in their oxygen levels. When they’re lying down on their back, the very severe and sick cases require quite (a lot of) oxygen support.

“But when we put them in the prone position, (these) requirements do come down,” he explained.

Pneumonia caused by Covid-19 often results in damage to patches of patients’ lungs, while other parts of the lung remain in good condition.

Dr Puah said pus and other fluids may build up in the damaged areas and, as people naturally tend to lie on their backs when they are resting, the back of such patients’ lungs tends to get inflamed.

This makes it difficult for oxygen to be exchanged there, and results in breathlessness and other complications.

However, when patients are in the prone position, blood is naturally redistributed because of gravity, allowing it to reach the parts of the lung that are still in good condition.

The body can then process the oxygen that the blood carries.

Dr Puah said that international trials have shown that it is beneficial to put patients in the prone position for about 16 hours a day, before turning them over to rest on their backs.

This is because lying on one’s stomach puts pressure on other body parts, and cannot be done for too long.

He added that there is a lot of ongoing research on the benefits of putting patients in the prone position, and that more time is needed to tell whether it will aid in the overall recovery of Covid-19 patients.

One immediate benefit remains clear – it helps such patients feel less breathless, and reduces the amount of oxygen support they need.

Dr Puah said that the prone position is also being tried out on non-ICU patients in NCID.

However, he cautioned that this should not be taken as a blanket recommendation for all sick people to lie on their stomachs, and that the position is only suitable for patients who meet certain criteria.

This would include those whose bodies have trouble processing oxygen, and who do not have heart, back, spinal or blood pressure issues.

It also does not have any implications on the sleeping position of healthy people.

“It’s best to leave it up to health professionals to decide when it’s needed, when one is unwell,” he said.

Dr Puah also gave his thoughts on a video that had been circulating online, telling patients to remain as active as possible in order to fight the infection.

He said that remaining active – while not overstraining – is important to beat any disease, as long periods of being bed-bound can weaken the muscles in a person’s body.

He explained: “If you were a marathon runner who ran a couple of marathons, then you fell sick and decided not to run marathons for two years, you’d find yourself unable to hit that pace again.

“Similarly, if… all you do is lie in bed for the next two weeks to four weeks, all your muscles will definitely become (weaker). This is especially so for the older folks, who will probably need a lot more physical therapy and rehabilitation to get them back to their original physical state.”

He added: “We’re not asking you to go and do high-intensity interval training when you’re sick, but just don’t be too bed-bound, especially if you can afford to move around a bit.”

Source: Read Full Article