Pneumonia and patient placement

Health Watch

It’s one of the lessons from the hospital frontlines and it was reinforced during the recent coronavirus pandemic positioning matters.

A significant percentage of pneumonia patients who were placed on their stomachs or sides early on, were able to avoid mechanical ventilation.

As patients began to flood hospitals in March and April, ventilators were in short supply. That’s when some emergency doctors began to rethink patients’ positions in bed. Traditionally, on their backs.

Nicholas Caputo, MD, MSc, FACEP, FAAEM, MAJ, associate chief and attending physician in the department of emergency medicine at NYC Health and Hospitals explained, “Just by the weight of your media sternum, your heart and your chest on the lungs, it collapses some of the spaces of the lungs. You turn the patients over, and what that does is that helps to open up some of the collapsed alveoli.”

Airway specialist Dr. Richard Levitan volunteered at a New York hospital for ten days and saw the benefits and the drawbacks of being awake in a prone position.

“Patients sometimes are uncomfortable laying down on their stomach. And I came up with the idea to use a pregnancy massage cushion as a way to help patients lay on their stomach comfortably,” Dr. Levitan recalled.

Dr. Levitan coordinated with a California company that made proning boosters and had some distributed to several New York hospitals. At the same time, Levitan and Dr. Caputo did a small study following 50 COVID patients who were placed in a prone position at one hospital in the Bronx.

“And in those 50 patients within the first 24 hours we were able to avoid intubation in three quarters of them.”

A small change in position making a life-altering difference in some COVID patients.

Dr. Levitan has since formed the non-profit Prone2Help which distributes the proning mattresses to hospitals. To date, Prone2Help has distributed more than 650 proning cushions to more than 200 hospitals in 45 states.

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