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Study: Lying Face Down Improves Breathing in Severe COVID-19 Cases | Medicine – Sci-News.com

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In a study of patients with the severe COVID-19 disease hospitalized on ventilators, a team of researchers in Wuhan, China, found that lying face down was better for the lungs.

In a study of patients with the severe COVID-19 disease hospitalized on ventilators, a team of researchers in Wuhan, China, found that lying face down was better for the lungs.
36-year old male with history of recent travel to Wuhan, presenting with fever, fatigue and myalgias. Coronal thin-section non-contrast CT image shows ground-glass opacities with a rounded morphology in both upper lobes (arrows). Image credit: Chung et al, doi: 10.1148/radiol.2020200230.
Southeast Universitys Professor Haibo Qiu, Zhongda Hospitals Professor Chun Pan and colleagues were in charge of the treatment of 12 patients with severe COVID-19-related acute respiratory distress syndrome (ARDS), who were transferred from other treatment centers to Wuhan Jinyintan Hospital.
The observational study took place during a six-day period the week of February 18, 2020.
This study is the first description of the behavior of the lungs in patients with severe COVID-19 requiring mechanical ventilation and receiving positive pressure, Professor Qiu said.
It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed (facing downward).
The clinicians in Wuhan used an index, the Recruitment-to-Inflation ratio, that measures the response of lungs to pressure (lung recruitability).
They assessed the effect of body positioning. Prone positioning was performed for 24-hour periods in which patients had persistently low levels of blood oxygenation.
Oxygen flow, lung volume and airway pressure were measured by devices on patients ventilators.
Other measurements were taken, including the aeration of their airway passages and calculations were done to measure recruitability.
Seven patients received at least one session of prone positioning. Three patients received both prone positioning and ECMO (life support, replacing the function of heart and lungs). Three patients died.
Patients who did not receive prone positioning had poor lung recruitability, while alternating supine (face upward) and prone positioning was associated with increased lung recruitability.
It is only a small number of patients, but our study shows that many patients did not re-open their lungs under high positive pressure and may be exposed to more harm than benefit in trying to increase the pressure, Professor Pan said.
By contrast, the lung improves when the patient is in the prone position.
Considering this can be done, it is important for the management of patients with severe COVID-19 requiring mechanical ventilation.
The teams paper was published in the American Journal of Respiratory and Critical Care Medicine.
_____ Chun Pan et al. Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study. American Journal of Respiratory and Critical Care Medicine, published online March 23, 2020; doi: 10.1164/rccm.202003-0527LE

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