The Many Sides Of Patient Care - think, that
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The Many Sides Of Patient Care - sorry, that
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The pandemic continues to rage in the US, and the number of people hospitalized with Covid has now surpassed its prior peaks of about 60, in April and July. Th one trend line is mercifully falling: A much smaller proportion of these critically ill patients are dying from the disease, as compared to the spring.
It would be helpful if we could say exactly why. Even the drug that seems most likely to have had a major effect, a generic steroid known as dexamethasone, cut deaths among Covid patients on ventilators by only 12 percent in the largest study.
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Proning, as an emergency medical procedure, is far from new. Ina community ICU nurse in central Michigan named Margaret Piehl and Robert Brown, a doctor who had served in Vietnam, co-authored a paper detailing their observations The Many Sides Of Patient Care prone positioning benefited five patients with a potentially deadly fluid build-up in the lungs known as acute respiratory distress syndrome, or ARDS for short. He and Piehl used an electric, rotating bed mounted on hoops to flip their patients over—not that low tech, perhaps. Today, hospital workers work together to move patients in regular hospital beds first onto their sides, and then their fronts, with a rolled blanket underneath a leg and an arm to alleviate Tne pressure.
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Since the lungs of patients with severe Covid are at risk of fatal fluid buildup, nurses and doctors realized early on that the same approach might be very helpful. Already in the spring, proning was being heralded as a major improvement in the standard of care.
Before I reached out to them, neither Piehl nor Brown had heard that proning was now being used to treat patients in this pandemic. Both were delighted to hear the news.
Proning should not be overlooked as a key intervention, Topol says: It may well have been more transformative of patient care than remdesivir, blood thinners, dexamethasone, or any other drug to date. The procedure does seem to elevate levels of much-needed oxygen in the blood of Covid patients, but mortality rates are what matter most. A July paper from scientists in China Te that among non-intubated Covid patients, the day survival of those who were placed in the prone position early on was 57 percent compared with 24 percent for those who were not.
But the Chinese study may have methodological flaws. Aline Almeida Gulart, a physiotherapist at the Cardiology Institute of Santa Catarina, and a colleague noted in a correspondence to the same journal that many of the patients in the Chinese study who were not put in the prone position also did not receive mechanical ventilation which is not always associated with intubation. Could this perhaps explain the vast difference in mortality rates? Read all of our coronavirus coverage here.]
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