Patients placed on their stomachs. These are the impressive images of the intensive care of severe forms of covid-19. And it is thanks to a French resuscitator that this positioning is today at the heart of the treatment of the most serious respiratory distress.

In the intensive care unit of the Edouard Herriot hospital in Lyon, Prof. Claude Guérin and his young colleague, Prof. Martin Cour, manage patients whose lungs are so damaged that they can no longer breathe on their own. They are asleep, intubated and oxygenated by a machine. The most seriously affected patients should be regularly placed on their stomach. A position called prone position.

Reopen the lungs at the back

It is an astonishing treatment described by Prof. Martin Cour, medical resuscitator: “The patient developed the most severe form of covid-19, which is acute respiratory distress syndrome.” First interest, the prone position allows “decrease the amount of oxygen administered to the patient”. Here, to achieve 98% oxygen saturation, this patient needed 60% oxygen supply while on his back. In prone position, the quantity of oxygen necessary to reach the same saturation is only 40%.

Second interest: “reopen the parts of the lungs which may have shriveled in the back”, continues Prof. Cour. The back of the lung is no longer crushed by the weight of the body and the lungs are no longer distended. The alveoli, which are already suffering from the disease, are protected. Breathing is then extremely soft and controlled. Thus protected, the lungs can heal instead of suffering additional damage.

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A resuscitation technique that saves

The decubitus technique has been used for several years for influenza epidemics. This saving gesture is therefore now controlled in an optimum way.

But it took a few years to get to these results. In 1985, Professor Claude Guérin was a young doctor when one of his colleagues was inspired by an American publication to save “desperate” cases.

In 2000, after years of hard work with several other hospital services, he launched his first scientific study. The results are negative, there is no decrease in mortality. However, he remains convinced and understands that the patients were not left on their stomachs long enough. He managed to convince his colleagues to do it for more than 16 hours in a row.

A reduction in observed mortality

Based on the successful experience, the teams provided a solution that will be adopted for nearly 80% of COVID patients in intensive care. The toll of this epidemic would surely be much heavier without the prone position. Professor Guérin also received a lot of calls from the United States and Canada last spring, during the first wave of the pandemic.

Prevention of pressure ulcers

One concern persists: that of the prevention of pressure sores on the face, the skin of which is so fragile. To do this, caregivers use special dressings placed on the nose and forehead. The other key to this protection is changing sides every two hours.

All of these techniques have now been adopted by intensive care units around the world to cope with covid-19. Now that the prone position has found its place, all their patients in respiratory distress will be able to benefit from it, even when SARS-CoV-2 has been defeated.

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