Why are Covid-19 patients in intensive care placed on their stomachs?

Photo: ČTK / Ondřej Deml

Why are patients with serious cases of Covid-19 placed on their stomachs? Doctors say the so-called “prone” position helps intubated patients with acute respiratory distress syndrome. There is now an ongoing medical debate about whether positioning on the abdomen could help patients with less severe cases of Covid-19 infection as well.

Photo: ČTK / Miroslav Chaloupka

As Czech hospitals fill up with Covid patients, one of the things that strike people in the daily reports from medical facilities is the number of patients in intensive care units who are lying on their stomachs. The practice of placing patients with respiratory distress syndrome on their stomachs spread at medical institutions around the world seven years ago after French doctors published an article in the New England Journal of Medicine showing that patients with ARDS who were on ventilators had a lower chance of dying if they were placed in this position.

Professor Pavel Ševčík, Head of the Department of Anaesthesiology, Resuscitation and Intensive Care at the University Hospital in Ostrava explains why the “prone” position helps to save lives.

Pavel Ševčík, photo: Archive of Krajská zdravotní (hospital)

“The lung in which an inflammation is taking place swells. Small blood vessels, capillaries, become more permeable, and fluid gets where it shouldn’t be.  This prevents oxygen getting into the body and carbon dioxide out of the body."

At that point, doctors turn the patient on their abdomen to improve blood flow and ventilate the back of the lungs. The lungs are divided into several sections and turning the patient on their stomach opens up parts of the lungs that were previously squished by the weight of the body. Physicians can also more easily draw secretions that form in the lungs.

Tomáš Vymazal, head of the Department of Anaesthesiology, Resuscitation and Intensive Care, at Prague’s Motol University Hospital says only patients on ventilators are turned onto their abdomen. The recommended number of hours for which patients can remain lying on their stomachs differs. Much depends on the patient's condition. There is a risk of bruising and injury to the skin, especially in overweight patients who frequently have severe cases of Covid-19, so they need to be repositioned after several hours.

Ostrava University Hospital, photo: Aktron, Wikimedia Commons, CC BY 3.0

In Ostrava University Hospital, patients are often left lying on their stomachs for up to 18 hours. According to Professor Ševčík, doctors must be sure that they can handle it without problems.

"The patient must be placed so that the position he or she is in does not cause other complications. It is essential to have a well-supported chest and pelvis and to keep the abdomen free. It's quite a sophisticated process."

There is an ongoing debate about whether positioning on the abdomen can help patients without a ventilator as well, by helping more oxygen to enter the bloodstream and thus prevent serious complications. So far research in this area is lacking. The 2013 French study looked only at patients who were on ventilators, so it is not clear how beneficial the stomach position is for patients who are not as severely ill. However the method is being tried and tested abroad so fresh data may soon be available.