YouTube: Doctor at Queens Hospital in the UK advises on potential lifesaving corona virus breathing technique

https://www.youtube.com/watch?v=HwLzAdriec0

 

Is there any evidence to support this? It looks like traditional physio advice for clearing secretions from lungs in people lying in bed.

It may be the opposite of what is needed for an ARDS syndrome like Covid19. It will exaggerate negative airway pressure. The point of ventilation and CPAP used for Covid19 is to replace negative airway pressure with positive airway pressure. That reduces the risk of inflammatory fluid being sucked into air spaces by breathing in.

 

Just watching a news item from an ICU - they are turning patients onto their fronts regularly. Apparently that does help with lung function....

 

they were doing this in Italy early on and they were not getting the response to treatment that they expected; ie it was not working and they didn't know why.

https://www.youtube.com/watch?v=rfkbv_WQtn0

 

Turning patients is a traditional method in physiotherapy as part of 'postural drainage'. I doubt that it is all that relevant to an acute lung problem like Covid19. The cough is dry. The purpose of postural drainage is largely to encourage flow of wet secretions in bronchi. Turning of patients immobilised on ventilators probably helps prevents alveolar collapse as well but the most important thing for that is adequate positive pressure inflation.

 

JK Rowling says she had coronavirus symptoms and that doing these exercises helped in her recovery.

https://www.studentproblems.com/j-k-rowling-recovers-at-home-after-showing-coronavirus-symptoms/

I’ve seen this video being shared but haven’t tried them. I’m very worried about when the doctor says lying on your back is not good as it closes off a lot of the small airways. And he says to lie on your front. But I cannot lie on my front as I find it difficult to breathe lying on my front even at the best of times, and it also puts a lot of pressure on my gallbladder area which hurts too much.

 

I don’t really understand what positive airway pressure or negative airway pressure is @Jonathan Edwards - is positive airway pressure achieved when you lie on your back, so is lying on your back the better thing to do? Or are you saying the position is irrelevant?

I have found this.
Association of Chartered Physiotherapists in Respiratory Care

For ward care (ie currently moderate patients, I think):

“Positioning seems to have a variable effect on the patient from what has been seen so far. Limited trials of prone lying in appropriate, spontaneously ventilating patients has been shown to have good effect but these have been poorly tolerated by patients –this will need to be evaluated further as our experience with these patients’ increases.“

I am not sure what they are recommending for severe patients.

https://mailchi.mp/58a036d4bca3/e-newsletter-6412444?e=26239c1ec5

 

I can't lie on my front either. In my case the problem is adhesions and scarring affecting my abdomen. A few years ago I had an MRI scan and was asked to lie on my front, and it took about 40 minutes as far as I remember. I wasn't aware of it while the MRI was going on but a few minutes after I got up I collapsed in agony because blood flow must have been shut off to lots of bits of my bowel and surrounding areas. As blood flow resumed again after I took the pressure off my abdomen the pain was excruciating. It was like the pain that happens when bits of you "go to sleep" for a very long time and it was affecting a large proportion of my abdomen. I think just being on my front for long enough could kill off my bowel due to lack of blood flow.

 

Looking at the new thread about changing the ventilation protocol away from positive pressure and towards more oxygen what is clear is that so far doctors and physios are using what they have used for other things assuming it will work but it may turn out that Covid19 needs a very different approach. We need hard evidence. It sounds as if that may be obtained in the next week or so. It seems that an ARDS pressure protocol may not be right after all.

Change in posture does not make a lot of difference to airway pressure but can prevent small air passages collapsing down. It is more a case of moving around being good than one position better than another.

 

@Jonathan Edwards any thoughts on the use of extracorporeal membrane oxygenation (ECMO). @wigglethemouse higlighted ECMO in a post recently.

 

ECMO can maintain oxygen levels under conditions where lungs are so damaged they cannot do it even with oxygen inflow. The problem is that ECMO involves a risk of activation of the clotting system in the blood and it may be that activation of the clotting system is the crucial factor in multi-organ failure in Covid19. Multiorgan failure in sepsis is often associated with what is known as diffuse intravascular coagulation - which leads to blockage of kidney glomeruli and renal failure. ECMO is all very well if you have one patient requiring it and plenty of staff to handle the complex control of both machine and patient physiology. I suspect it is just too labour intensive to be a realistic option for large numbers of people with Covid19. There is also the problem of contamination of equipment with virus and repeated sterilisation.

 

From what I read it improves oxygen saturation. No idea how that works but that's the reason I've seen for ED physicians recommending it.