As the second wave of Covid-19 sweeps through the country with deadly consequences, doctors across the state have started advocating proning exercises to improve oxygen levels in Covid positive patients — both in home isolation as well as in hospital. The Indian Express finds out more about proning, its benefits and how it can save lives at a time when liquid oxygen supply and shortage has emerged as one of the major flashpoints between the state and the central government.

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What is proning?

Proning a medically approved position — which is also being promoted by the Union Ministry of Health and Family Welfare — in which patients are made to lie on their abdomen to boost their oxygen levels. Proning has its immediate benefits, as in the recent case of an 82-year-old Covid positive patient from Gorakhpur, whose oxygen levels improved from 75 to 94 after sleeping in a prone position, as per a news report published in an English daily. Proning as an exercise is being advised to Covid patients in hospitals, so that they may not require additional oxygen support.

What are proning positions?

While proned, the patient is made to lie on his/her belly using pillows. One can also lie on their right side( right lateral), left side ( left lateral) or sit at a 60-90 degree angle in the ‘fowler position’.

Medically, doctors suggest that a patient remain prone for a minimum of 30 minutes to a maximum of 2 hours. “This helps improve ventilation to the lungs and hence oxygen levels start improving,” said Dr Surendra Gupta, a Ludhiana-based doctor.

How does it improve oxygen levels?

If Oxygen saturation is (SpO2) drops below 94, timely proning and maintaining good ventilation can save a life, said Dr Gupta. Proning improves ventilation to the lungs, and keeps the alveoli units (tiny balloon shaped structures that are the smallest passageway in the respiratory system) open, thereby easing breathing, say the guidelines issued by the Union Ministry of Health.

What is needed for proning?

All we need for proning are 4-5 pillows. One pillow is to be placed below the neck, 1-2 pillows below the chest through upper thighs, and 2 pillows below the shins. A patient should lie on their belly, right and left side alternately. However, experts suggest that at least 30 minutes should be spent in each proned position for best results.

When should we avoid proning?

Proning should not be practiced during pregnancy, or by patients who have deep venous thrombosis (treated in less than 48 hours). Patients with major cardiac conditions, unstable spine femur or pelvic fractures should avoid proning, suggests a help book that has been circulated by the Ludhiana district administration for the citizens.

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Dos and don’ts in proning

Avoid proning for an hour after meals. One should stay in one position for as much time as it is tolerable for them. Pillows can be adjusted slightly to alter the pressure areas and comfort. The room in which the patient is lying should be well ventilated. One should not ignore any pressure sores and injuries. The Ministry of Health says that one can be prone for upto 16 hours a day in multiple cycles, if it is comfortable for the patient.

What are the other ways to improve oxygen levels while in home isolation?

Deep breathing, yogic pranayama, ample access to fresh air, staying hydrated, eating iron-rich foods, light exercises also help in improving oxygen level of patients, the Health Ministry suggests.

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