Health Editor’s Note: Proning is positioning a patient on his or her belly with chest and face down. This position has been proving to make it easier for patients with COVID-19 to breath and decreasing the chances they will need to be placed onto a ventilator. The prone position changes the physiology and mechanics of gas (oygen and carbon dioxide) exchange and improves oxygen levels in the blood. Someone who is on a ventilator can also be placed into the prone position…..Carol
MHS – Defending the Homeland: Proning made easy at Keesler Air Force Base
COVID-19 has presented many challenges to the medical community. Among those challenges is treating patients with respiratory failure. Adult respiratory distress syndrome, or ARDS, is a complication of COVID-19 among intensive care unit patients. To address this issue, a team from the Air Force’s 81st Medical Group, or MDG, at the Keesler Medical Center aboard Keesler Air Force Base near Biloxi, Mississippi, prototyped a “proning shelf” that can be attached to an ICU bed. The shelf helps ARDS patients rest in a position that allows easier breathing.
“Our Keesler Medical Center medics are leading the way in innovating new care techniques for COVID-19 patients,” said Air Force Col. Beatrice Dolihite, service commander of the MDG at Keesler. “The ability to place patients in a proning position was seen by our team as part of the medical care plan needed to treat COVID-19. We are very excited to have this capability in our ICU.”
ARDS is a respiratory illness that reduces the working area of the lungs. That reduction causes low oxygen levels in the body. Patients with ARDS are placed on a ventilator and sedated for comfort. However, ICU patients rest on their backs in bed, causing gravity to pool fluids and increase pressure at the base of the lungs. Providers reverse that gravitational pull by placing patients in a “pronated position,” or face down.
Placing a sedated, ventilated patient face-down results in additional challenges, such as making sure ventilator tubes are secured and free from bends or obstructions. Hospitals normally lease specialty beds for the few patients that may need pronation. Now these beds are in short supply as the country combats the COVID-19 pandemic.
The MDG’s Education and Training Flight, led by Air Force Maj. Mark Gosling, developed instructions for how to use normal ICU beds to prone patients. The process uses pillows, multiple layers of sheets, and procedures to safeguard all IV lines and tubing necessary to treat the patient.
“Our education department works with other departments on a routine basis, as we are a supportive department for the MDG,” Gosling said. “My team is excellent at pulling together resources to solve problems.”
The team later discovered that the prone position leaves the head and neck turned to one side. Long periods of time in such a position lead to problems for the airway and neck. Ideally the patient’s head would face straight down and still be supported. The position must also leave the airway tubing free and able to ventilate.