Why do we prone patients with COVID-19 and ARDS?

[@ICUAdvantage]

Thank you guys so much for watching! Please leave a like if you enjoyed the video. I truly do appreciate it! Also I love hearing your comments so feel free to tell me what you think of the video. Also, I have a Patreon now! 😍 If you are looking for additional content 💻and more information 📝to go along with these videos, then please consider showing support over there! www.patreon.com/icuadvantage 👍🏼Don't forget to check me out and give us a like on Facebook & Instagram as well! facebook.com/ICUAdvantage instagram.com/ICUAdvantage 🎥👁 Don't forget to check out these other great series of lessons that I have available! Hemodynamics: kzbin.info/aero/PL2oVjKTYocdMBZlcIcWlESbOFFaGugQS2 Shock: kzbin.info/aero/PL2oVjKTYocdPP0K8Fi49GfUgprICS-xMf Arterial Blood Gases: kzbin.info/aero/PL2oVjKTYocdMz1qF-3iS6iUZ-R_fKbeJw ECG/EKG Interpretation: kzbin.info/aero/PL2oVjKTYocdPMaNwn4xbg6xAIaAnyraMj Heart Failure: kzbin.info/aero/PL2oVjKTYocdNdFoS31yGhylKwib9lRf73 Endocrine System: kzbin.info/aero/PL2oVjKTYocdO74cmXgmKjexoq59j93-Wv 🤷‍♂️🤓 OR these individual lessons! Blood Tubes - Order of Draw: kzbin.info/www/bejne/o3LQqJd6mceei6s Glasgow Coma Scale: kzbin.info/www/bejne/sIrae4mGfs-KbKs

[@drpratikgupta1373]

I'm a recently graduated doctor in COVID-19 ICU, your videos have helped me lot to save my patients. Thank you😇

[@ICUAdvantage]

Amazing to hear Pratik! Take care!

[@dylantobiasflynn9576]

Thank you for all you do!

[@jessiejimenez9420]

Thanxs for your service God bless you brother

[@mrlilnomad]

@@simchakaplan7329 A shame no one responded to your stupid comment. Videos are absolutely a valid form of didactics. Hopefully you never become a doctor (probably won’t) because, from this one comment, you have demonstrated that you do not understand tools of learning.

[@raphaelwedd6204]

@@simchakaplan7329 and we found the idiot

[@michaeljohnson3132]

In December 2021 I ended up in the hospital for two weeks with double Covid pneumonia with sepsis. I watched this video while I was in there and it made a lot of sense so I actually proned myself for about 20 hours a day. I was on 90 L forced air oxygen per minute and within two weeks made it down to 6 L per minute cannula. I was able to walk out of that hospital room. I was on supplemental oxygen at home and finally got off of that April 1 of 2022. Long long road to recovery to get to where I’m at today as I’m writing this but I just wanna thank you for this video as it played a role in my recovery process big time.

[@ICUAdvantage]

So sorry to hear you had to go through this Michael, but I'm glad to hear that you have made it through and are on your road to recovery. Wishing you the best in your recovery. Thanks so much for taking the time to pop back in here. Happy to know this video was able to help in some way.

[@michaeljohnson3132]

Thank you! Im fully recovered now.

[@Marilynefc]

Amazing video!! Everyone always tells me “ it just helps. “ but I wanted more information. The triangles were a great way of teaching ☺️

[@ICUAdvantage]

Yay! So glad to read this. Glad that you enjoyed the video. I'm a very visual person so the "triangles" helps me see it.

[@parisazamani1751]

The best lesson and the most understandable explanation that I have ever seen about “proning “. Thank you so much for making this complicated and confusing subject so clear. You are amazing. 👍👏

[@ICUAdvantage]

Than you so much!!! Appreciate you! Glad you liked it! 😊

[@coribellanoche]

I am a practicing neonatologist with almost 40 years of experience at the bedside. It is refreshing to see the adult critical care world take a page out of our playbook as we have been "proning" patients for decades. The lessons of improving V/Q matching have been well established in the literature. The only difference between your patients and mine is that we do not an army of care givers to turn our patients. Greetings from Rapid City, SD.

[@ICUAdvantage]

Yeah its quite interesting as now, even with non-covid patients, I feel we prone a lot more than we did before COVID.

[@gabrielleblake4347]

currently have covid and am watching this in a prone position lol. very informative video! My care team recommended pronation and I was curious as to why just a position change seemed to help my breathing so much - I learned a lot and feel better knowing exactly why this works. Thanks for making such comprehensive content! :)

[@michellependergrass8479]

I am a home hospice nurse and have had quite a few covid patients lately. This is such great info

[@ICUAdvantage]

Thank you Michelle! Glad you liked it.

[@yzmaronmione]

Your illustrations along with actual patient imaging scans really helped a lot. Thank you for putting this here!

[@ICUAdvantage]

Absolutely my pleasure and thanks for taking the time to leave a comment.

[@annebertucci4056]

Thanks for your videos I found them by accident when I was looking up a medical therapy out of curiosity, but I keep watching them because I’m studying for my medical coding credential and understanding how patients are treated and which drugs do what is going to be helpful when I need to understand medical records. You explain everything in a way that I can understand, I’m not a nurse but I’ve had pathopharmacology, so I understand stuff on the basic level.

[@ICUAdvantage]

Glad that you stumbled across the channel and happy to know you have found the info helpful!

[@stelyussilveira3499]

Even for a foreign nurse, it's easy to understand you. Thank you for all information!

[@ICUAdvantage]

Glad it was helpful!

[@bonniehuang8696]

this is the most thorough video on proning with the super helpful drawings! Thank you! We also have COVID patients, alert/not intubated, self-proning, which is so much more easier.

[@ICUAdvantage]

Really glad you liked it Bonnie. And yes, much easier when they self prone!

[@Kris-cu1vx]

Thank you so much for this! I *really* needed the imagery to understand how this works

[@ICUAdvantage]

You're so welcome! Glad this was a helpful video for ya!

[@TrickyLittleMiss953]

THANK YOU so much for this video, I have such a hard time explaining things to family members, and that triangle imagery is an awesome way to describe it, thank you!

[@ICUAdvantage]

So cool! Glad it was helpful!

[@annofgreencables]

When I was first diagnosed as being Asthmatic, I instinctively slept on my stomach when it flared up. That was many years ago . It is under control and now I have a proper name for it my instinctual sleep method. Pronation.

[@gamkousa9632]

Thanks for the upload, the prone position works best and has a high patient outcome.

[@ICUAdvantage]

Yes it is really an amazing therapy option and even without a fancy bed, is quite easy to implement. I hope to see proning take a more central role in therapy after covid.

[@ananda7469]

Can someone tell how effective prone position is I'm really worried my mother is getting treated in prone position. Pls boost some confidence 😭😭😭😭

[@isisvanderpaardt5861]

Thank you for your informative videos! I am definitely one of your biggest fans. I had two more video suggestions that may be cool to do. First, a video on EVD's (extraventricular drains) and maybe one with an explanation of the reason behind, dosaging, and cycle of drugs used during codes. As I am in more codes, I feel more and more confident in medication administration, but I remember feeling so flustered and lost during my first couple of codes.

[@ICUAdvantage]

You are very welcome Isis! Those are some good suggestions. I do actually have both of those on the todo list to get to eventually! 😊 Hopefully sooner than later, but I do have A LOT on the todo list to try and work through haha.

[@ΑργυρώΔρικάκη]

Congratulations!! I'm not a Dr. but I Believe You are really excellent in Your tutorials and information!! I have realized just now why so many COVID patients in ICU have died here in Greece this year!! Going on to 23.000 people!!! I'm almost certain that they have NEVER tried this!! Plus lack of staff and lack of team work!!! I wish there were cameras in ICUs what a world of difference it would make!!!🇬🇷👍

[@ICUAdvantage]

It'll be interesting as we eventually look back and try and learn more. I'm curious after all this how much of an impact it had on mortality with COVID. I'm sure it had some, but for many it seems to not matter. It definitely is one part of giving them the best fighting chance for sure. I also fully agree about cameras. Even badge cams like police officers wear and just let people really see the reality of it all. Even then, I don't think those who haven't care probably still won't unfortunately.

[@ΑργυρώΔρικάκη]

@@ICUAdvantage 🇬🇷👍😭❣️

[@watsonpho1]

Thank you. This was very helpful. I am an epidemiologist and so I have been working and focusing on prevention, contact tracing and community interventions. Unfortunately, like too many of us, COVID has now touched me personally. My father was diagnosed with COVID-19 2 weeks ago and is now on a vent in the ICU. They started proning the first day, and I wanted to understand the ventilation situation and the physiology of his care. This (and your vent videos) have been invaluable in helping me understand so that I can explain to the rest of my non-medical family. Stay safe!

[@ICUAdvantage]

Will keep you and your father in my thoughts and hoping for a quick turn around. Glad this video was able to help you in some way.

[@hasmukhraitrivedi5261]

Great effort sir...mind blowing I think One thing to be added is the weight of diaphragm itself on the basal parts of lungs

[@ICUAdvantage]

Thank you!

[@shannonpickens7695]

Super awesome and very thorough!! I honestly ever knew the lungs were shaped like that! I always thought proning was to essentially move secretions and change pressure around in the thoracic cavity. Thus improving ventilation. Thanks so much for the videos!!

[@ICUAdvantage]

Glad you liked it and learned something! 😊

[@riodepalma1]

You have to take the heart into account, in supine, the heart sits mostly anterior to the lungs causing downward pressure, and if you prone the pt. the heart now is posterior and not causing a lot of pressure to the lungs and the lungs can expand more upward in supine.

[@ICUAdvantage]

Exactly! One of the factors in the benefit of proning.

[@paulasocha5804]

Very informative videos. Thank you so much! What would be reasons for not proning a patient? Are there certain situtations where a patieint should not be proned? Or, could the risk outweigh the benefit? My husband has been in the ICU, on a ventilator for 7 days and has only been proned once for about 12 hours. When I've asked the hospital, they don't give a clear explanation of why they are not proning him. I have not been able to go to the hospital because, I too had Covid. Advocating for him over the telephone has been very difficult.

[@mohamedhabibberhanu6553]

I really appreciate what you have done, it is great job 👍👍

[@ICUAdvantage]

Thank you so much Mohamed! I appreciate that and glad you liked it!

[@kgf8256]

kzbin.info/www/bejne/h2mYk4uAptV8pZY

[@rietakeda1398]

Love your videos. Currently my bf is fighting with covid19. He’s on high flow O2 at 30lpm while proning. Already received convalescent plasma and currently on Remdesivir, dexamethasone, azithromycin and ceftriaxone. They are also planning to give him tocilizumab. Also plans to do hemoperfusion :( Hoping and praying that he will recover soon. 😭🙏❤️

[@ICUAdvantage]

I'm so sorry to hear this and of your BFs fight with this. It sounds like he has a great team watching out, caring for, and working to save him. You and him will be in my thoughts and prayers!

[@rietakeda1398]

Thank you so much ❤️❤️❤️❤️

[@samuelbustamante1855]

@@rietakeda1398 how is your boyfriend?

[@rietakeda1398]

@@samuelbustamante1855 i apologize for the super late response. He survived ☺️❤️🙏 Hemoperfusion really helped him recover :)

[@samuelbustamante1855]

@@rietakeda1398 incredible I’m happy to hear that stay safe!!

[@ingridboric3552]

Proning is the most effective treatment for severe COVID-19 pneumonia. ICU where I work we are doing manual proning. We even have handouts for patients not on ventilators so they can prone themselves. You can see improvements in O2Sat immediately, and improvements in PF ratio in couple of hours. Unfortunately proning doesn’t work on everybody, some patients that are already hemodynamically unstable, don’t tolerate flipping, or soon after being placed in prone position they have drastic changes in VS, but those patients that start proning early have better outcomes, and recover sooner. Proning is done now in the ER on COVID + patients with respiratory symptoms, before they are admitted to the hospital.

[@ICUAdvantage]

Thank you for sharing Ingrid and I 100% agree with everything. We have made huge strides in our use of pruning, both awake/early and in the ICU for the sicker patients. It doesn't fix the problem, but can help to buy them time to recovery. I imagine moving forward past COVID, that we will make more use of the manual proning in the future.

[@onlyoneliveableearth3651]

Recently had Covid 19, and, belly down, with neck extension (as on CPR) was, as almost allways, the best way to sleep. Also had a weird experience: I drank one and a half liter of linden tea, in 24 hours, because, although I was doing fine, breathing normally, I had been drinking very little. Hours after, I went from breathing normally to breathing as if I had the strongest flue, with the difference that with a flue, I would be coughing and spitting out mucus, to breath better, and with Covid, I tried to do the same, but with no sucess because there was a bulk inside, but all dry, nothing would come out, and I had to breathe through a tiny hole. As if the huge amount of liquid I drank had been used to expand tissue and block breathing. After this I reduced drastically, this time deliberately, fluid intake, and again in matter of hours I could breathe almost normally.

[@shilpakelkar4269]

BRILLIANT EXPLANATION ... loved it ........ watching your video for great understanding

[@ICUAdvantage]

Thank you! Really glad that you liked it!

[@christopherreddick9731]

Ight. You convinced me. I gotta pay for the free stuff (gonna hit up patreon). It's all too good - I hope you never stop making content.

[@ICUAdvantage]

Haha thanks Christopher! I really appreciate your willingness to help support my efforts. I certainly plan to keep going for quite some time!

[@anuragpadhy763]

Mind blowing.. excellent.... So very very neatly and lucidly explained..... ❤️ I wonder from where do u get these texts and explanations and then simplify it...

[@ICUAdvantage]

Thank you very much! I'm glad that you liked it. I honestly collection info from several different sources and then combine that with what I have learned over the years.

[@veronicasaavedra6073]

Thank you for making all these videos

[@ICUAdvantage]

You are very welcome Veronica! Glad you enjoy them.

[@jobyjoy7043]

Loved this channel

[@ICUAdvantage]

Awesome!!!

[@neethuraj5290]

Your videos are soo helpful,thank you soo much 🙏

[@arulvelk]

Thank you so much.. It was such an informative video so clearly explained.. Appreciate your hard work..👍👍👏👏👏

[@ICUAdvantage]

My pleasure 😊 Glad you liked it!

[@ryanfarkas106]

Excellent overview

[@ICUAdvantage]

Thank you!

[@justylex]

I am curious. Would it be at all beneficial for mild covid cases, those recovering at home, to sleep in prone position during the night?

[@ICUAdvantage]

It certainly wouldn't hurt, but in mild cases its probably not going to have much benefit as there are physiological reasons why it is helpful based on the disease progression.

[@onlyoneliveableearth3651]

On fall and winter I allways sleep belly down, with a double squared camping matress and a pillow under my chest, and with neck extension to open airways. I never tested for sleep apnea, but that is how I sleep the best. Recently had Covid 19, at home, and fell asleep the same way, plus too hot water bags to relieve the first days pin pricks on both sides of my chest.

[@conniethomas4753]

Missed the party here as a RN taught myself to sleep on stomach as heard about China a cruise liner in Japan & Italian nurses. We tried to early prone on medical wards & starve off ITU.

[@amytimmons3264]

Look at the pro nova bed, rotoprone is a antique

[@dailyjuniar4428]

Awesome information Appreciete you..

[@ICUAdvantage]

Thank you and I really appreciate you and the kind words! Glad you liked it!

[@emilychevarie1141]

Sooo helpful thank you!!

[@ICUAdvantage]

You're so welcome!

[@joshmaliske8745]

Dead space is ventilation without perfusion whereas you referred to it the other way around.

[@ICUAdvantage]

Yup def messed that up

[@kennethweiss9068]

Incredibly well done! Ty

[@jinheelee842]

Thank you so much! This is really helpful.

[@ICUAdvantage]

Awesome! Glad to help!

[@jenniferjackson7710]

This was unbelievably beneficial for me to understand proning better for COVID patients or ARDS ICU care

[@ICUAdvantage]

Glad to hear you liked it Jennifer! 😊

[@MedGems]

Awesome. Just awesome 👌 👏 👍.

[@ICUAdvantage]

Thanks a lot 😊

[@JonJaeden]

Is there an advantage to also breathing steam or hot moist air while proning?

[@NB-nh2sf]

I did this with covid every day because I just hated coughing in bed. I was soncwrned about lung health. I'm glad I did.

[@laurenprather9839]

This helped me so much!!! THANK YOU

[@ICUAdvantage]

So happy to hear this Lauren. Thank you for taking the time to leave a comment.

[@annetheflorist2248]

is proning will help to increase oxygen level?

[@ICUAdvantage]

Yes, that is part of it.

[@bossmag6228]

IMHO ventilation can cause microtrauma to alveoli in patients presenting congestion. It might seem weird, but wouldn't it help to have patients lie in an inverted, head-down position to have gravity help drain the lungs?

[@ZzzBliss]

Any recommendations for people who have covid but don't have insurance and cant afford consultation? The cheapest telemedicine I've been able to find is 12$ a month w subscription... but I have bills to pay w no income while quarantined. Tested positive 11 days ago. I have a more medium than mild case of covid, but have family who lost their battles with this virus. I'm also immunocompromised due to previous respiratory infections and kidney infections in the past. I would visit local urgent care but it costs a couple hundred $. The hospitals are full here, and costly, so I'd rather not go unless absolutely necessary. Just seeking options for broke people, basically. (no ivermectin bs plz)

[@joycew4171]

Thank you for sharing. God bless.

[@ICUAdvantage]

You are so welcome

[@kgf8256]

kzbin.info/www/bejne/h2mYk4uAptV8pZY

[@deeflofont7689]

Just discovered your site. Very informative therefore I subscribed ☺️.

[@ICUAdvantage]

Awesome Dee! Welcome aboard, glad you found it!

[@margaretdarr5558]

Very Good. Thank you.

[@ICUAdvantage]

Thank you too!

[@thepowerofpositivity8075]

You’re very good at teaching and explaining anatomy, physiology, and pathophysiology. I am impressed and appreciated your dedication for your KZbin videos. Have you ever considered to obtain higher degree and go into teaching? Thank you.

[@ICUAdvantage]

Wow, thank you Mien! I'm really glad you like these videos! Honestly, I enjoy doing this for fun on the side so I really don't have a desire to go in to formal teaching.

[@JGPRAISINGOD]

I'm just a nurse

[@TouFast91]

I'm in recovery right now. I just need to get my anxiety under control and stay proned all night for a couple nights

[@aprilapril2]

Brilliant. Thank you

[@ICUAdvantage]

You're very welcome!

[@gloriahall4728]

This was a great video!

[@ICUAdvantage]

Thank you!

[@kgf8256]

kzbin.info/www/bejne/h2mYk4uAptV8pZY

[@benhunter6053]

Hey Eddie! I love watching your videos! I graduate from nursing school this spring and will apply as a new grad to the ICU. What are some things I can do now to improve my resume??

[@ICUAdvantage]

So awesome to hear this Ben! Thank you! Congrats on almost being done with nursing school. Its a huge accomplishment. Honestly theres not a ton to do beforehand other than just try to do the best you can in school. Your orientation in your new job will teach you SO MUCH more. If you have an opportunity to get a preceptorship in the ICU, this is a great opportunity to meet the manager and look to get an interview and/or job offering. Same goes for your critical care rotation. Mention that you want to work ICU and hopefully this can get you an introduction to the management team. Best of luck!

[@charlottefreeman4191]

Thanks!

[@ICUAdvantage]

Thank you so much for this Charlotte!

[@viviliberton6196]

Some patients are 'non-responders' to proning. I saw some of these COVID patients in ICU, but have never heard an explanation for it. Why don't they respond? Can you predict who will respond to proning and who won't (aka are there factors that predict a non-responders)?

[@ICUAdvantage]

I'm not sure if there is any predictor for it at least not that I'm aware of.

[@ahmedtoom9914]

I have a question, i am currently sick and when i am sleeping i would wake up suddenly feeling like im going to choke because their is something in my throat that is making me cough, and i do have to spit mucus right after. These are followed up with temporary fever, headache, and post nasal drip. Would you be able to tell me exactly whats wrong with me if that is covid or something else? Thanks!

[@elizama8587]

Thanks you YAHWEH bless you

[@ICUAdvantage]

Thank you!

[@dr.jamalalansi4979]

U R GREAT

[@ICUAdvantage]

Thank you Jamal!

[@kgf8256]

kzbin.info/www/bejne/h2mYk4uAptV8pZY

[@YeahJerrickT]

RRT posseee! Thank you for the amazing video! I appreciate it ❤

[@ICUAdvantage]

Haha awesome!!! You are very welcome! Thanks for the amazing comment! Glad you enjoyed it.

[@mariespi96]

Is it beneficial to prone a patient on ECMO?

[@ICUAdvantage]

Great question. While I have seen it done, and theoretically in some cases, perhaps... it is quite complex and not ideal with cannulation. In most cases of recoverable cases, the support via ECMO should be enough to meet the demands of the patient. I can't say for certain, but it would be interesting to see a large meta analysis of data on concurrent proning with ECMO to see if there is any benefit, although the complexities and risks I wonder if they would outweigh any marginal advantage.

[@mariespi96]

@@ICUAdvantage Thank you!❤

[@brookeweaver426]

Is there ever a scenario where proning is not feasible? I have a family member in the ICU and they're telling us they can't prone him. Why wouldn't they do this if it's helping?

[@ZzzBliss]

Hope they survived! Sometimes when it is already too far into progression, flipping someone into prone becomes a risk.

[@brookeweaver426]

@@ZzzBliss Sadly they did not.

[@hh-wv1bd]

Thanks a lot

[@ICUAdvantage]

You are very welcome!

[@hh-wv1bd]

@@ICUAdvantage thank you sir. I am learning many things from you. I am a doctor from india. Here we have guidance to take HCQ as prophylaxis for all the frontliners of COVID. May i know wheter HCQ is used as prophylaxis in US or other countries.

[@imcogito5856]

how magnesium helps in this case?

[@ICUAdvantage]

In what case?

[@imcogito5856]

@@ICUAdvantage covid cases?

[@kgf8256]

kzbin.info/www/bejne/h2mYk4uAptV8pZY

[@nayanpatel6444]

is proning possible with ecmo

[@ICUAdvantage]

It is. Not ideal and really a pain, but it has been done.

[@juanzuniga7616]

The amount of patients that died proned is incredible, it doesn’t work unless you think surviving is ending up trached and bedbound

[@ICUAdvantage]

To say it doesn’t work is just false

[@anusha12341]

What is P:F ratio?

[@ICUAdvantage]

PaO2 to FiO2 ratio.

[@pitcherine5842]

ايدي واتسون شكرا

[@tanzzz1000]

Is the improvement from proning temporary or long lasting?

[@ICUAdvantage]

Heyy Tanvi, good question. The effects are primarily temporary in the sense of the direct effects that we see. That said, there are long lasting benefits to doing so which ultimately is the end goal. Hope that makes sense!

[@jimmykowalczyk4711]

Imagine if you could utilize a body pillow or pregnancy pillow.

[@VireshUpaseRollNothterm]

Good

[@ICUAdvantage]

Thank you

[@maryjanekeao2351]

🤠♥️👍🏽 Thx

[@you7tube7Abukhaled]

We do indeed know how thy heart is distressed at what they say. But celebrate the praises of thy Lord, and be of those who prostrate themselves in adoration. Quran We do prostration in our 5-time daily prayers in Islam

[@amool7rb915]

The humdrum deposit phylogenetically please because fine connolly dance apropos a little poultry. marked, spiteful passbook

[@salahuldin8699]

Allah (swt) said in the Glorious Quran Indeed, We know that your breast becomes tight because of what they say. So glorify the praises of your Lord and be of those who prostrate themselves. Sura 15 verses 97 and 98 This was reviled more than 1400 years ago to the prophet Muhammad peace and blessings be upon him. If COVID patients prostate like Muslims do it will help them a lot.