Proning

What is proning?
It means turning the patient onto his or her front. One arm is usually raised above his or her head, with the other by their side, in what’s sometimes called the “swimmer’s position”. It can look a bit strange to see. 

Why is it done?
Proning has been used internationally, and for many years, to improve lung oxygen in patients with severe respiratory (breathing) problems.  

How is it done?
Patient safety and comfort are very, very important. Patients will receive sedative and analgesic drugs (painkillers) to keep them sleepy and comfortable, and sometimes drugs to relax their muscles.  Proning is a very carefully planned procedure, usually involving a team of up to 6 people, and led by a doctor. There are detailed safety checks before, during and afterwards. Because many Intensive Care patients with COVID-19 are cared for in the prone position, some ICUs have dedicated “proning teams”. This means that the whole process is as quick and as safe as possible.

How long is it done for?
Patients can be proned for long periods of time, sometimes for more than 16 hours a day, before being turned onto their backs. Some patients can only tolerate being cared for in the prone position for much shorter periods of time, though.

Is it safe?
There are some situations in which it’s not safe to care for patients in the prone position e.g. after a head injury, abdominal or heart surgery. The main risks during the procedure are tubes or lines becoming kinked or dislodged.  Other complications include temporary swelling of the eyes and face. Proned patients may be at slightly higher risk of developing pressure sores, due to spending long periods of time in the same position, but this will be very carefully monitored by staff. In the longer term, some patients develop shoulder injuries e.g. joint pain or stiffness, or tingling in the arms and fingers.