COVID-19 Second Wave in India: Are You Facing Difficulty in Breathing? Here Is Everything About Proning To Restore Oxygen Level

·7-min read

During the second wave of the ongoing COVID-19 pandemic, an increase in oxygen requirement has been reported in patients. According to Dr. Ravichandra, Chief Medical Officer, National Tuberculosis Institute, Bangalore, “80% of COVID-19 cases reported are mild. Only 15% COVID patients may have a moderate disease where one’s oxygen saturation level may go less than 94%. And the remaining 5% COVID infected people may end up having a severe disease which shows respiratory rate higher than 30 per minute and oxygen saturation level less than 90% said In this video, let us take a look at some important aspects involved in restoring oxygen levels in the body, for the benefit of the small proportion of patients who end up needing supplemental oxygen.”

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Be alert and learn about the symptoms of Low Oxygen Level

One should be aware of the warning signs of low oxygen levels in the body. It includes difficulty in breathing, confusion, difficulty in waking up and bluish lips or face. Adults can develop chest pain that persists. Symptoms in children include flaring up of nostrils, grunting while breathing or inability to drink or eat. What is Proning? How To Do It Correctly? Everything the Indian Health Ministry Says About the Medically Accepted Position to Improve Breathing and Oxygenation.

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What do the experts say?

One needs to be alert, in case, you are experiencing any kind of low oxygen symptoms. According to WHO, Hypoxemia which is the low oxygen levels in the blood may eventually result in loss of life. When oxygen levels become low because of a sickness such as COVID-19, the cells in the body don’t get enough oxygen to perform their normal functions. If the level remains low for long, maybe due to lack of treatment, organs start to malfunction; in severe cases, it may cause death.

Here is how to Measure Oxygen Level

In the current scenario, it is very important to be aware and cautious. One must be alert to catch the signs sent by the body. The department of health and doctors have issued certain guidelines for the general public to understand and measure the oxygen levels.

There are two easy ways to measure the oxygen level.

1. Pulse Oximeter: You can measure the oxygen level of a patient using a pulse oximeter which you can place on their finger, toe or earlobe. It’s a painless test, taking less than two minutes.

Pulse oximeters measure the oxygen saturation or percentage of oxygen in the patient’s blood. According to a WHO training manual on pulse oximetry, if the oxygen saturation is 93% or lower, the patient needs to be treated quickly. A saturation of less than 90% is a clinical emergency.

What to do if you don’t have a pulse oximeter?

Respiratory Rate: Respiratory rate is the number of breaths a person takes per minute. Dr. Somashekhara, Director, National Tuberculosis Institute, Bangalore explained a simple method to measure the respiratory rate without any device.

Here is what the doctor said:

- Keep your palm on your chest, measure your respiratory rate for 1 minute.

-If the respiratory rate is less than 24 per minute, your oxygen level is safe.

-If a patient has more than 30 breaths per minute, the oxygen level is low.

What to do when you face a low oxygen level?

Proning

The first answer is proning. It is a medically accepted position to improves breathing comfort and oxygenation. It is extremely beneficial in COVID-19 patients with compromised breathing comfort, especially during home isolation.

Patients undergoing home care are advised to lie prone on their stomachs. This will improve breathing and increase oxygen saturation. Proning is the process of turning a patient with precise, safe motions, from their back onto their abdomen that is stomach, so the individual is lying face down.

Why Proning?

Prone positioning improves ventilation. It keeps alveolar units open and hence breathing become easy.

Proning is required only when the patient feels difficulty in breathing and the SpO2 decreases below 94.

Regular monitoring of SpO2, along with other signs like temperature, blood pressure and blood sugar, is important during home isolation.

Missing out on hypoxia which is the compromised Oxygen circulation can lead to worsening of complications. Hence, timely proning and maintaining good ventilation could save many lives.

Awake Proning Position:

According to Clinical Management Protocol for COVID-19 in Adults, released by the Union Health Ministry on May 24, 2021, awake proning should be encouraged in all patients who require supplemental oxygen therapy.
How to position your pillows?

For proning, the only requirement is the pillow. One might need 4-5 pillows for the same.

-Place one pillow below the neck

-One or two pillows below the chest through upper thighs

- And two pillows below the shins

For Self-proning:

-You need to keep in mind to regularly alter the lying position

-The best is to not spend more than 30 minutes in each position

Thing keep in mind while proning:

-Avoid proning for an hour after meals

- Maintain proning for only as many times as easily tolerable

-One may prone for up to 16 hours a day, in multiple cycles, as felt comfortable

-Pillows can be adjusted slightly to alter pressure areas and for comfort

-Keep a track of any pressure sores or injuries, especially, around bony prominences

Who needs to avoid proning?

-If you are pregnant

-If you have deep venous thrombosis (treated in less than 48 hours)

-In case of major cardiac conditions

-If you have an unstable spine, femur, or pelvic fractures

What do for non-self pronating patients (in an emergency):

Follow this five-step method to place a patient in the prone position using a regular bed, flat sheet, and help of family members.

Using a flat sheet, pull the patient to one side of the bed. Place the flat sheet around the arm that will pull through (the side you are turning toward).

A second flat sheet is placed on the bed and tucked under the patient. This sheet will pull through as you are turning the patient.

Using the sheet, turn the patient over and position the patient prone. The arm and sheet will pull across the bed.

Pull and center the patient.

Discard the sheet that was used to place the patient in the supine position. Straighten lines and tubes.

2. Using oxygen concentrators:

Experts suggest that oxygen therapy may be given only in presence of a healthcare provider. However, one may use them in an emergency, while medical attention is being sought or while waiting for an ambulance.

“Oxygen concentrators can be used only in moderate cases of COVID-19 when the patient experiences a drop in oxygen levels, where the oxygen requirement is a maximum of 5 litres per minute,” said Prof. Sanyogita Naik, Professor and Head of Department, Anaesthesia, B. J. Medical College, Pune.

The professor added that oxygen concentrators are also very useful for patients experiencing post-COVID complications which necessitate oxygen therapy.

When to stop the oxygen therapy?

One needs to understand that the goal of oxygen therapy is to achieve a saturation level of 94%; once the patient has 93% to 94% oxygen level, the oxygen therapy may be discontinued.

Excess of oxygen may lead to an increase in the level of Carbon Dioxide, leading to complications.

In any case, it is never advised to be a doctor yourself or google the solutions. Take proper advice from authentic sources and consult an expert whenever in doubt.

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