I’ve seen an image on social media that suggests postural drainage, a physical therapy practice used mostly for cystic fibrosis, as a way to cope with COVID-19 at a sub-hospitalization stage; the shared image suggests that draining the mucus can keep a patient from needing a ventilator. (I’ll transcribe the actual text attached to the image in a subthread, but it’s of pretty low quality; I’ve written here what I think is the only interesting point.)
Unfortunately, Googling “postural drainage coronavirus” just gets me all the medical pages on postural drainage (because they now have headers about coronavirus).
It’s a very cheap intervention for patients not on ventilators, the mechanism seems at least plausible, and it’s the sort of thing that medical professionals might fail to consider. Is it worth taking a closer look?
Movement is also important to help prevent congestion and keep the lungs inflated, for example post-op care for thoracotomy patients (where the chest wall has been opened which collapses the lung) is mainly about mobilisation—getting out of bed and walking around as soon as possible.
On TWiV 595 they did an interview with a doctor who said he’d been able to get the survival rate of intubated patients up to 50% by using proning, though I don’t recall them going into the details.
Supine positioning is the easiest position for intubation but once the endotracheal tube is in-situ it makes physiological sense to turn the patient over if possible. Assuming the tube is secured in place—which it should be.
Main issues with a prone intubated patient are medical staff accessing/assessing/maintaining the tube—requiring suitable facilities or having to kneel on the floor!
Some patients, by taking oxygen and rolling onto their sides or on their bellies, have quickly returned to normal levels. The tactic is called proning.
[...]
At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said.
No one knows yet if this will be a lasting remedy, Dr. Caputo said, but if he could go back to early March, he would advise himself and others: “Don’t jump to intubation.”
[...]
Dr. Josh Farkas, who specializes in pulmonary and critical care medicine at the University of Vermont, said the risks of proning were low. “This is a simple technique which is safe and fairly easy to do,” Dr. Farkas said. “I started doing this some years ago in occasional patients, but never imagined that it would become this widespread and useful.”
So wow, something like this (just the basic version like leggi was discussing, putting patients on their belly instead of their back) is proving to be strikingly effective:
The biggest change: Instead of quickly sedating people who had shockingly low levels of oxygen and then putting them on mechanical ventilators, many doctors are now keeping patients conscious, having them roll over in bed, recline in chairs and continue to breathe on their own — with additional oxygen — for as long as possible.
The idea is to get them off their backs and thereby make more lung available.
[...]
Some patients, by taking oxygen and rolling onto their sides or on their bellies, have quickly returned to normal levels [of blood oxygen level]. The tactic is called proning.
Text of the shared image; don’t say I didn’t warn you about the quality of the writing, and [sic] for the whole thing. It does read like it could really be from an elderly physical therapist.
If you end up with pulmonary symptoms of corona virus pneumonia… there can be lethal damage from effusion (mucous filling lungs) or cytokine storm (body over-reacts with more effusion.
This kills people… ESPECIALLY when the number of patients is greater than the number of ICU beds or ventilators. You will be left to drown in your mucous. That mucous can also be infected by other germs during your struggle. That is happening in Italy where they have 5x more patients than they have hospital beds. And the USA has FEWER hospital beds per population than does Italy.
Many years ago, physical therapists have successfully treated this with POSTURAL DRAINAGE… where the patient is tipped over a wedge to tilt the lungs and bronchial tubes upside down… to allow the mucous to flow out, where it can be coughed out.
Google it. It is EASY to do for yourself and your family members. Simply get in position and let it flow, helping it along with breathing techniques that emphasize full, prolonged exhale, while puffing your cheeks and you blow out long and steady.
Start as soon as you feel lungs getting filled. Don’t wait until you are too sick to bother. 3-5 minutes several times per day.
I did this inside a nursing home in VT during the 1976 flu epidemic for resident patients. We did not lose anyone, while other nursing homes lost dozens. It is an old PT technique that has faded away since we have ventilators and related machines. BUT this time, we will NOT have nearly enough ventilators, not the ICU beds where they are provided.
One easy way to get into position is to lie over an EXERCISE BALL.
So wow, something like this (just the basic version, putting patients on their belly instead of their back) is proving to be strikingly effective:
The biggest change: Instead of quickly sedating people who had shockingly low levels of oxygen and then putting them on mechanical ventilators, many doctors are now keeping patients conscious, having them roll over in bed, recline in chairs and continue to breathe on their own — with additional oxygen — for as long as possible.
The idea is to get them off their backs and thereby make more lung available.
[...]
Some patients, by taking oxygen and rolling onto their sides or on their bellies, have quickly returned to normal levels [of blood oxygen level]. The tactic is called proning.
I’ve seen an image on social media that suggests postural drainage, a physical therapy practice used mostly for cystic fibrosis, as a way to cope with COVID-19 at a sub-hospitalization stage; the shared image suggests that draining the mucus can keep a patient from needing a ventilator. (I’ll transcribe the actual text attached to the image in a subthread, but it’s of pretty low quality; I’ve written here what I think is the only interesting point.)
Unfortunately, Googling “postural drainage coronavirus” just gets me all the medical pages on postural drainage (because they now have headers about coronavirus).
It’s a very cheap intervention for patients not on ventilators, the mechanism seems at least plausible, and it’s the sort of thing that medical professionals might fail to consider. Is it worth taking a closer look?
This is the link I was looking for (but couldn’t find!) for my previous answer:
Proning the non-intubated patient
Written by Josh Farkas assistant professor of Pulmonary and Critical Care Medicine at the University of Vermont.
Some general comments.
Positioning affects lung capacity and function.
Images (figure 1) and information to see the effects of gravity and compression of the lungs here and here.
Definitions:
supine ~ “facing up”
prone ~ “facing down”
More info: prone-ventilation-for-adult-patients-with-acute-respiratory-distress-syndrome
Proning the non-intubated patient
Movement is also important to help prevent congestion and keep the lungs inflated, for example post-op care for thoracotomy patients (where the chest wall has been opened which collapses the lung) is mainly about mobilisation—getting out of bed and walking around as soon as possible.
So yes, definitely worth a closer look.
On TWiV 595 they did an interview with a doctor who said he’d been able to get the survival rate of intubated patients up to 50% by using proning, though I don’t recall them going into the details.
Supine positioning is the easiest position for intubation but once the endotracheal tube is in-situ it makes physiological sense to turn the patient over if possible. Assuming the tube is secured in place—which it should be.
Main issues with a prone intubated patient are medical staff accessing/assessing/maintaining the tube—requiring suitable facilities or having to kneel on the floor!
Supine and immobile for days—not good.
Some more on proning in this NYT article:
So wow, something like this (just the basic version like leggi was discussing, putting patients on their belly instead of their back) is proving to be strikingly effective:
Text of the shared image; don’t say I didn’t warn you about the quality of the writing, and [sic] for the whole thing. It does read like it could really be from an elderly physical therapist.
...and there the image ends.
So wow, something like this (just the basic version, putting patients on their belly instead of their back) is proving to be strikingly effective: