Doctors at Peking Union Medical College say | Feeling stuffy, short of breath, and unable to cough up phlegm? Doctors teach you how to "lie down" to get good blood oxygen levels

Stuffy, short of breath, can't cough up phlegm? "Prone ventilation" has recently appeared frequently in media reports on the treatment of COVID-19 patients. Do you know about "prone ventilation"? Who is it suitable for? How effective is it? Can you do it at home? Today, let's learn about this "prone ventilation" method recommended by the "Diagnosis and Treatment Plan for Pneumonia Infected with New Coronavirus" with the doctors of Peking Union Medical College.

ask

What is prone ventilation? Why can it improve blood oxygen levels?

answer

In short, prone ventilation means "lying prone". By changing the patient's body position, the collapsed alveoli can be re-expanded, and the back alveoli can be promoted to "re-online"; the ventilation/blood flow ratio of the gravity-dependent area of ​​the lung can be improved, and the blood oxygen saturation can be increased; the movement mode and position of the diaphragm can be improved, and with the help of gravity, it is more convenient for secretions such as sputum to flow out. In 1974, Bryan first proposed the concept of prone ventilation, which has been widely used in clinical practice. It is a simple, safe, economical and effective respiratory therapy method.

ask

Who needs to "lie down"?

answer

Moderate, severe and critical cases with high risk factors for severe illness and rapid disease progression should be given standardized prone treatment, and it is recommended to be no less than 12 hours a day.

Factors that increase your risk of severe illness include:

1. Those over 65 years old, especially those who have not received the full course of COVID-19 vaccination;

2. Patients with cardiovascular and cerebrovascular diseases (including hypertension), chronic lung diseases, diabetes, chronic liver and kidney diseases, tumors and other underlying diseases, as well as patients on maintenance dialysis;

3. Immune dysfunction (such as AIDS patients, long-term use of corticosteroids or other immunosuppressive drugs leading to immunodeficiency);

4. Obesity (BMI ≥ 30 kg/m2);

5. Women in late pregnancy and perinatal period;

6. Heavy smokers.

The diagnostic criteria for medium-type cases are: if the patient has persistent high fever for more than 3 days or (and) cough, shortness of breath, etc., but the respiratory rate is less than 30 times/minute, and the oxygen saturation when breathing air at rest is greater than 93%, characteristic manifestations of pneumonia caused by the new coronavirus can be seen in imaging.

ask

Who can’t “lie down”?

answer

Unstabilized spinal cord injury or fracture

Have glaucoma or other conditions that increase eye pressure

Severe arrhythmia

Wounds not healing after abdominal surgery

Intra-abdominal hypertension

Head and face injuries

Unrelieved increased intracranial pressure

Hemodynamic instability

Other rare situations where prone positioning is not appropriate

ask

How should the prone position be implemented?

answer

Step 1. Preparation: Prepare three pillows or thick cushions.

Step 2: Turn over: With the help of others or by the patient, turn over to the prone position. The first pillow is placed under the patient's chest or abdomen, the second pillow is placed under the patient's forehead, and the third pillow is placed at the ankle. The patient's head is turned to a position that he or she finds comfortable.

The third step is to optimize the body position: place pillows and adjust the angle of the bed to reduce the pressure on the stressed parts and improve the patient's comfort. The knees should be slightly bent and the arms should be at a comfortable angle of 80°. The upper arms and shoulders should be kept horizontal.

Step 4: Monitoring: Monitor blood oxygen saturation, respiratory rate and comfort. If you feel uncomfortable, seek help immediately!

When in the prone position, the patient's head needs to be turned to one side at least every 2 hours. If necessary, pressure sore patches can be used to protect the face and ears to avoid pressure sores.

When you lie prone for the first time, you can get used to it by lying on your stomach for 1-2 hours. After that, you should try to extend it to 4 hours each time, with a total of at least 12 hours of prone time per day.

ask

If “lying over” is uncomfortable, what are some alternatives?

answer

A comfortable position can increase the time spent in prone position. If the above recommended position makes the patient feel uncomfortable, it can be fine-tuned, but the general principle is to maintain the "lying" position. In addition, you can try to shorten the time spent in prone position and increase the number of times you do it. You can distract yourself by watching TV or playing with your phone. But it should be noted that the most important thing is to increase the time spent in prone position as much as possible, and strive to exceed 12 hours a day.

About the author: Liu Shengjun

Clinical postdoctoral fellow in the Department of Critical Care Medicine, Doctor of Medicine, his main research direction is the application of machine learning in the field of critical care medicine. As the project leader, he is responsible for the first "Xiehe Xingyuan Plan" health science cultivation project. He has won the National Postgraduate Scholarship and the first prize of the "Young Teachers Teaching Basic Skills Competition" of Peking Union Medical College Hospital. In the past five years, he has published more than ten SCI papers in international academic journals.

Audit expert: Long Yun

Director of the Department of Critical Care Medicine, chief physician, professor, has been committed to the clinical and scientific research fields of critical care medicine for a long time. He is currently the chairman of the Critical Care Branch of the Chinese Society of Health Information and Health Medical Big Data, the deputy director of the Critical Care Medicine Quality Control and Evaluation Center of the National Health Commission, the standing committee member of the Critical Care Medicine Branch of the Chinese Medical Doctor Association, the deputy director of the Critical Care Branch of the Beijing Medical Association, and the standing committee member of the Critical Care Branch of the Chinese Society of Pathophysiology.

Audit expert: Li Zunzhu

Head nurse of the Department of Critical Care Medicine, deputy chief nurse. Excellent nurse in Beijing, outstanding nursing worker of the Chinese Nursing Association. Currently serving as the chairman of the Male Nurses Working Committee of the Chinese Nursing Association, deputy leader of the Youth Committee of the Critical Care Professional Committee of the Chinese Nursing Association, and secretary of the Hospital Infection Management Committee of the Beijing Nursing Association.

Content from: Liu Shengjun, a doctor at Peking Union Medical College Hospital