What is proning? The position that coronavirus patients should lie in - and what happened to Stacey Fresco explained
A technique called proning has made headlines after mother-of-two Stacey Fresco, who had hours to live, was saved using the risky technique.
This is what you need to know about proning - and how it saved Stacey’s life.
What happened with Stacey Fresco?
Mother-of-two Stacey Fresco had been given just hours to live by doctors at Whipps Cross Hospital in East London after her condition continued to deteriorate in the intensive care unit on Mother's Day.
Her family had prepared for the worse, and her two daughters, aged 21 and 23, and her husband Adam had said their goodbyes.
Speaking to Sky News, Adam said: “I remember saying to the doctor, ‘is there anything weird or wacky you can do [to save her] that has worked anywhere else?’, which is an impossible question for him to answer.”
That’s when the doctors returned with one last effort to save Stacey.
“When we were back in the waiting room, Dr Dave came back in and said, ‘Look, there’s one more thing we can try’, and he described proning. But the caveat was that it was really risky… and would more than likely lead to a fatal heart attack,” Adam said.
It was the act of proning that saved Stacey’s life. After a few days in different units, Stacey would spend a further 20 days recovering in the hospital before she was able to go home.
Talking about her current condition, Adam said: “She’s really good. She’s exhausted, she’s very weak. She says she feels like she’s been hit by several trucks.
“But everyday I can see that she’s getting slightly stronger. And we’ve got time whether it takes six weeks or six months. We’ve got time for her to recuperate, which I’m just eternally grateful for.”
What is proning?
Proning, or prone positioning involves moving an intensive care patient onto their stomach for 12 hours to move fluid that has gathered in their lungs.
The technique increases oxygen flow and promotes the use of different parts of the lungs, which lowers their chances of needing ventilation.
By reducing invasive ventilation procedures, proning can also reduce the chance of death in conscious Covid-19 patients.
However proning also comes with risks, including heart attacks and airway obstruction.
Is proning recommended for coronavirus patients?
Guidance from the Intensive Care Society (ICS) in the UK states that clinicians should consider lying patients who are in need of basic respiratory support on their stomachs, which is known as proning.
Proning has been used for unconscious patients in intensive care units for years, and it’s been discovered that it can also help coronavirus patients.
The guidance from the ICS says that the technique is “compatible with all forms of respiratory support and requires little or no equipment in the conscious patients”.
Patients diagnosed with coronavirus often die from ARDS - acute respiratory distress syndrome. This same syndrome can also prove fatal for patients with influenza, pneumonia and other similar diseases.
In 2013, a study in the New England Journal of Medicine showed that patients with ARDS who were also on ventilators had a lower chance of death if they were placed on their stomachs.
The ICS says: “Over the last two decades, randomised controlled trials have consistently demonstrated that oxygenation can be significantly improved in patients with acute respiratory distress syndrome (ARDS) when ventilated in the prone position.”
While proning is described as non-invasive, there are complications that can arise from this technique.
In the guidance from the ICS, it states that “although turning a patient into the prone position is not an invasive procedure, it is complex and has many potential complications”.
What are the risks of proning?
A study from 2014 in the Canadian Respiratory Journal said: “Complications, such as airway obstruction and endotracheal tube dislodgement, hypotension and arrhythmias, loss of venous access, facial and airway edema, and a greater need for paralysis or sedation, have all been associated with prone positioning with varying frequency.”
An airway obstruction means that there is a blockage in the patient's airway, which makes it difficult for them to breath as something is preventing air from getting into their lungs.
Hypotension is a medical term for low blood pressure - low blood pressure can result in the patient feeling sick, weak, confused and experience blurry vision.
Coronavirus: The Facts
COVID-19 is a respiratory illness that can affect lungs and airways. It is caused by a virus called coronavirus and is spread primarily through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose.
What are the symptoms?
The NHS states that you should not leave the home if you have either:
• a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
What should I do if I feel unwell?
Don’t go to your GP but instead look online at the coronavirus service that can tell you if you need medical help and what to do next. Only call 111 if you cannot get help online.
What precautions can be taken?
Washing your hands with soap and water thoroughly. The NHS also advises to cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze; put used tissues in the bin immediately and try to avoid close contact with people who are unwell. Also avoiding touching eyes, nose and mouth unless your hands are clean.
When can I go outside?
The Government has put the UK into lockdown and instructed everyone to stay at home. You should only leave your home for very limited purposes:
• shopping for basic necessities, for example food and medicine, which must be as infrequent as possible
• one form of exercise a day, for example a run, walk, or cycle – alone or with members of your household
• any medical need, including to donate blood, avoid or escape risk of injury or harm, or to provide care or to help a vulnerable person
• travelling for work purposes, but only where you cannot work from home
However, these reasons are exceptions – even when doing these activities, you should be minimising time spent outside of the home and ensuring you are 2 metres apart from anyone outside of your household.
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