All you need to know about the Proning technique


The advent of the second phase of Covid-19 has immensely increased the significance of breathing techniques. Practised in America for decades now, this technique allows and helps infected persons get a supply of oxygen through natural means. Doctors and many frontline workers recommend and encourage practising proning techniques as they continually prove to be extremely helpful during the pandemic.

Read on and learn all you need about the proning technique.;- 


What is Proning?

Jack Stewart, MD, a pulmonologist with St. Joseph Hospital in Orange County, California, explains proning as a medically accepted position where a patient lies horizontally on their stomach and chest rather than on their back. This is an easy way where medically ill covid patients can get oxygen supply without having to wait for oxygen cylinders and ventilators. 

It requires almost no equipment, just some pillows can do the trick.

A person needs to lie down on their stomach and needs some pillows to align the body to create a feasible position for the technique to work. One pillow is placed below the neck, two below the chest and upper thighs, another two below the shins, and finally, one below the head.

The patient also needs to change positions every half hour between lying down on the stomach to lying down on both sides, then finally sitting up before resuming to the first position.

How does it help?

The virus attacks the red blood cells and decreases the oxygen levels in the body. Proning helps because as Dr. Stewart says that a ‘prone position’ is ideal for getting oxygenated. The human body has a greater number of lung tissue in the back of the body. The abnormal fluids flow to the back where there is an increased number of tissues leading to greater interference with respiratory functions.

Harry Peled, MD of St. Jude Medical Center in Fullerton says that while in the prone position, gravity pulls the secretions downward and the good components remain at the top, thus it is less affected.

Proning also helps in treating ARDS (Acute Respiratory Distress Syndrome). It gradually progresses and results in the shortness of breath felt by patients, posing a great threat to life.

A study conducted by JAMA Internal Medicine showed that 40% of the patients admitted to the hospital due to covid developed ARDS and 50% of those identified lost their lives.

Patients suffering from influenza, pulmonary edema, and pneumonia are also at great risk from ARDS. 

The proning technique has been in use to treat ARDS for a long time now. According to a study published in the New England Journal of Medicine in 2013 by a group of French doctors, it was observed that patients suffering from ARDS could be saved if they practised proning at the beginning of their treatment.

How to do Proning?

Arrange 4-5 pillows for the patient and ask the patient to lie flat on their belly. Use one below the neck, place 1-2 below the chest and thighs, place 2 below the shin, and finally one below the head.

The patient needs to change positions every half hour in a specific pattern.

  • The first step is to turn the patient in a prone position i-e, make the patient lie flat on their stomach.
  • Then turn the patient laterally on the right side, after that make the patient sit up straight.
  • After then turn the patient laterally on the left side, 
  • Finally, make the patient lie in their prone position.
  • Change positions every half hour
  • Make sure to check the patient’s heart rate, blood pressure, and oxygenation level and try to keep it stable throughout.

Can anyone perform proning?

Proning can be practised even when no other help is around. But it is advisable to seek help from professionals when it is feasible.

Professionals like trained nurses with critical and operating room experience, physical therapists, patient-care technicians, anaesthesia physicians, occupational therapists, and respiratory therapists.

When to use the Proning technique?

In cases when the patients feel extreme difficulty in breathing and their oxygen levels drop below 94, proning can prove extremely beneficial. It is imperative to constantly check the temperature, blood pressure, blood sugar along with Spo2 levels using a pulse oximeter.

How long can you prone a patient?

A patient can perform the proning technique in multiple rounds for about 16-18 hours a day. After that, a person is advised to lie for about 6-8 hours horizontally in a supine position with their face looking up, only if they can tolerate the oxygen levels in that position.

When and who should not do proning?

  • Take a gap of an hour after meals. Do not jump to practise proning directly after having your food.
  • People with an unsteady spine, pelvic fractures, open wounds, burns, or people who have undergone tracheal surgery, or people with cardiac complications and pregnant women should consult a doctor or a critical care expert before undergoing proning techniques.

What could go wrong if not performed with caution?

It is essential to practise proning with extreme caution. It is better when it is performed by a professional. But it is important to know what could happen if it is not performed with care;-

  •  It may lead to obstruction in the airways.
  • There can be dislodgement in the endotracheal tube (a plastic tube, usually a flexible one that is placed through the mouth and inserted into the windpipe to help a patient breathe)
  • A person may undergo low blood pressure or hypotension
  • One may have swelled face or airways (edema)
  • One may undergo pressure-related skin injuries.
  • There is also an increased chance of an irregular heart rate (Arrhythmias)

Therefore, proning is an effective way to help people with respiratory problems such as ARDS which eventually leads to shortness of breath and harm. Sars Cov-2 infected persons undergo life-threatening situations as the virus directly attacks the respiratory tract.

Proning is an ideal way to get a natural supply of oxygen by lying down in specific positions and changing positions in a rhythmic time interval. It is also advised to seek professional help to avoid any side effects or injuries. Also, proning is not suitable for every person. Pregnant women, people with underlying medical conditions, cardiovascular complications, and obese people are advised to consult a medical expert before practising proning.