Proning: Self-Care Breathing Exercise For COVID-19 Patients

Coronavirus has reached its deadly stage. It has been observed that the patients suffering from COVID-19 have difficulty in breathing which causes a rapid decrease in their blood oxygen levels. Usually, the symptoms of this disease are visible after the lung gets damaged by 25%, resulting in a dip in oxygen saturation level to 80- 85%. In such a situation, an immediate oxygen supply is required. If oxygen is not available during this period, the patient may face complications. The cells in our body require at least 89% of the oxygen saturation level while healthy individuals have a saturation level of 95 and above. Any significant drop in this level causes breathlessness. With an increased demand for oxygen supply, medical institutes are overburdened and also the availability of ventilators is limited. Therefore, the best way to reduce our dependency upon hospitals and ventilators can be achieved by managing blood oxygen levels at our home by a natural method of proning. Proning is a technique used to optimize oxygenation, it is an easy to do home exercise. A method of attaining prone position is required when the patient feels discomfort while breathing and also when the oxygen level decreases below 94. In this blog, we will discuss proning and how it increases your oxygen supply.

 

Proning or Prone positioning:

Patients who are on ventilators due to pneumonia spend long hours lying on their back, due to which the fluid begins to enter the back of the lungs. The air breathed in cannot mix well with the blood flowing through the lungs. This is because of the pooling of fluid causing the lung tissue to collapse. The lung tissue in the back of the chest undergoes inflammation and infection-causing a decrease in the transfer of oxygen to the blood.  The patient ultimately becomes tired of breathing and exhausted with the effort of keeping the blood completely oxygenated. The best way to support breathing is by keeping the patient on a ventilator. But ventilators can often damage the lungs. Therefore, a safe and simple method to improve oxygenation is by prone position or proning. Prone position or proning opens up the collapsed airways and increases blood oxygen levels. In a prone lying position, the heart rests on the breast bone giving space for the lungs to expand, this increases the airflow to the back, where the blood circulation is the most. So, both blood circulation and more oxygen, lead to effective oxygenation.

 

Positioning

The patient lies in a prone posture on their abdomen or on their belly by facing down towards the bed. Keep a pillow below the neck and chest. Keep two pillows below each shin. Make sure that the patient lies comfortably, if not so the patient might feel suffocated. Do not spend more than half an hour in each position.

·         Lying on your stomach:

             Begin by lying on a bed by stomach facing towards the bed for 30 minutes.

 

·         Side-lying position to right side:

             For side-lying, lie on your right side for 30 minutes.

 

·         Sitting up:

             Sit up in the bed with your back supported and both legs extended for 30 minutes.

 

·         Side-lying position to left side:

             While lying in the bed lie on your left side for 30 minutes.

 

·         Lying on your stomach:

             Return to lying on your stomach by facing towards the bed for 30 minutes.

 

Benefits

·         It is a safe and simple home method to improve oxygenation.

·         It improves ventilation.

·         Helps the body to get air into all areas of the lungs.

·         Prevents worsening of complications due to decreased oxygen circulation.

·         Delays the use of mechanical ventilators by maintaining the supply of oxygen to the body tissues.

 

Safety measure

·         Avoid prone position or proning immediately after meals.

·         Maintain prone position till the patient feels comfortable.

·         Pillows should be kept under pressure areas especially around bony prominences.

 

Contraindications

Prone position should be avoided in conditions like:

·         Pregnancy.

·         Deep venous thrombosis.

·         Major cardiac conditions.

·         Fractures like spinal, femoral, or pelvic fractures.

 

In the current situation, Covid-19 cases are increasing and it has become obligatory for us to take necessary precautions and help prevent the further spread of the disease.

 

COVID-19 and related Lung Pathology

Let us go back to the time when COVID -19 was declared as a pandemic. At the end of 2019, a new virus, Coronavirus known as Severe Acute Respiratory Syndrome Corona Virus-2 or SARS-CoV2, caused an infection called COVID-19. It hit the world after originating from Wuhan, in China, and the World Health Organization (WHO) named the disease coronavirus disease 2019 (COVID-19). On January 30, 2020, it was declared a global health emergency. While safeguarding yourself from this disease, by taking all the necessary precautions and continuing with your Post COVID-19 rehabilitation, it is also important for you to understand this disease in a better way, you should first try to find out how it affects your lungs. In this blog, we will discuss the lung pathology related to COVID-19.

 

Lungs are two spongy organs situated in your chest under your ribs. The right lung is divided into three lobes, upper lobe, middle lobe, and lower lobe. The left lung is divided into two parts, the upper lobe, and the lower lobe. When you breathe, air flows in through your mouth and nose down through your trachea and airways into your lungs. The trachea divides at a junction known as Carina. The trachea divides at carina into two bronchi, which further divides into right and left smaller tree-like branches called Bronchioles. At the end of bronchioles are present tiny air sacs called Alveoli, at these alveoli gas exchange takes place. These sacs are surrounded by tiny blood vessels. Here oxygen from your lungs passes into your bloodstream to go to tissues throughout your body. The oxygen passes from the alveoli into the bloodstream and oxygen from the bloodstream enters into the alveoli. The lung is situated on a soft thin muscle called Diaphragm. The diaphragm also helps us to breathe. It is a very important organ that helps in breathing. The lungs are connected to the immune system through lymph nodes. The lymph nodes and their vessels carry bacteria and other toxic materials away from the lung, into other organs from where they get filtered out. If you get some infection from bacteria or viruses, you may develop pneumonia which is an infection of the lungs. Sometimes these germs in form of bacteria or viruses might enter the trachea and through bronchioles enter into air sacs (alveoli). Normally, the cells from the immune system attack these germs which prevent you from falling sick but if you are old aged or have some illness your immune system may become weak. Pneumonia-causing germs can overcome the immune system and attack your alveoli. This causes swelling or inflammation in alveoli, filling the alveoli with fluid making your body difficult to get the oxygen it needs. This causes difficulty in breathing, fever, chills, cough, and sputum production body ache, body weakness, muscle fatigue, muscle pain, and headache. These conditions can lead to serious complications like respiratory failure, the breathing becomes so hampered in the latter stages that you may require a machine called Ventilator to breathe.

COVID-19 is such a disease caused by a virus. The virus infects cells along your airways by attaching to ACE2 and other molecules in these cells. The virus uses ACE2 as a door to reach into the cells and then replicates itself. The virus reduces the ACE2 inflammation system reaction, this inflammation damages the air sacs causing them to scar and stiffen or fill with fluid. This blocks some oxygen from passing from your lungs into the blood thus causing the oxygen levels to fall and you may feel short of breath. Researchers think that the virus latches onto the molecule to get into the cells. The effect of ACE2 to reduce inflammation is lost when the virus occupies ACE2. Researches have been done to focus on delivering safe and effective treatments for people infected with SARS-COV2.

People with diabetes, chronic lung disease, and heart or blood disease may be at higher risk of severe illness from COVID-19. We should all take steps to help protect ourselves and others from infection by wearing a mask and keeping a distance of at least one meter while interacting. And also don't forget to sanitize.