WV’S COVID Crisis: A look at ‘proning,’ where patients spend 16 hours a day sedated on their stomachs

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October 31 2021 11:59 pm

***AUTHOR’S NOTE: Under ordinary circumstances, most hospitals would not grant media access to their ICU, nor would our news organization seek it. The extreme seriousness of the situation in hospitals across West Virginia led WVU Medicine officials and us to come to the conclusion that this information needed to get out to the public. While in the COVID ICU, our staff did not enter any patient rooms and did not interfere with patient care. All of the video and still images associated with this series of reports was reviewed by WVU Medicine officials to insure patient privacy.

MORGANTOWN, W.Va. – Throughout the pandemic, coronavirus press conferences and newscasts have been full of mentions of available ICU beds, ventilators and of the suffering COVID-19 patients go through. Unless you contracted and survived COVID, watched a loved one go through it, or work in the healthcare field, it may be hard to understand what this all means and why it is important. That’s why WVU Medicine officials recently allowed us inside the COVID ICU at Ruby Memorial Hospital, in Morgantown.

Many of the COVID patients in the worst shape are being heavily sedated and spending 16 hours a day on their stomachs. It’s part of a medical procedure called “proning,” that while not new, has taken center stage in many ICUs as one of the last-ditch efforts used to try to save COVID patients.

“Prior to COVID, we would prone occasionally. It was something that we certainly were familiar with and did, but it was more for bad pneumonia, severe lung bruising after trauma. Now, it’s almost routine. At any day, almost half the patients in here (the COVID ICU) may require proning and it’s a very time-dependent resource,” explained Dr. Alison Wilson, the Executive Chair of the WVU Critical Care & Trauma Institute, in Morgantown.

Dr. Wilson went on to tell us that prior to the pandemic, proning was something almost exclusively reserved for ICUs like the one at Ruby Memorial Hospital, but now, due to patients spending longer periods of time at much smaller hospitals, while they wait for a bed to open up at a larger facility like Ruby or CAMC, the smaller medical centers are turning to proning too. It’s something that’s “unheard of,” Dr. Wilson said, but doctors and nurses at the smaller facilities are “so desperate to try anything that works, they’re willing to do it,” she said.

Medical ICU Nurse Manager Cara Hawkins explained the proning process to us.

We take a patient, where you normally lay on your back, when you sleep, we lay you on your belly. Your face is down and you’re laying in that position and you lay in that position for several hours, like 16 hours. You’re on heavy sedation and medications that prevent you from moving, so you can have good ventilation on the ventilator. That takes a lot of nursing care and physicians and respiratory therapists and nurses aides to help assist with those patients.

A whiteboard at each nurse’s station lists the proning schedules in the COVID ICU. During our time in the ICU, we saw a number of patients in the prone position and were there to observe one patient go through the process. The sheer number of personnel needed to accomplish the procedure gets your attention. Anywhere from six to 10 doctors, nurses, respiratory therapists and nurses aides suit up in full PPE before entering the patient’s room. A doctor, and a nurse in a managerial position, watch from outside the room, ready to run in with a crash cart should anything go wrong.

Hawkins talked us through the proning procedure we saw. You can watch and hear her description in the video below:

COVID seems to attack those with existing conditions the worst. One of those existing conditions is obesity. Many of the patients who require proning weigh quite a bit, requiring larger medical teams and a lot of strength and teamwork to safely flip the patients over during the delicate process. Going through this process, multiple times a day, with multiple patients, is challenging for the staff, Hawkins told us as her team finished up the latest proning procedure.

A medical team in the COVID Medical ICU work together to flip a patient during a proning procedure

Dr. Wilson explained to us what they are trying to accomplish by proning a patient. “Why that works is when you lay on your back, the blood goes to the parts of the lung, but then the air goes to the top of the wall. And so when you prone them, now you’re taking and you’re shunting blood to the place where all the air was able to get, the oxygen was able to get. And now you’re letting more air come up to what now had more blood flow, but not as much oxygen and air. So by routinely flipping them back and forth, proning them, then you can meet that demand a little better and improve their oxygen. Proning is now almost routine in the care, if they get to the point we can’t oxygenate them through normal methods.”

The “ultimate rescue,” Dr. Wilson told us, is something called ECMO. Ruby Memorial has six ECMO units, which would be considered a reasonably large center, Dr. Wilson said, but with only six units, decisions have to be made. “If I got COVID and got that sick, I would not qualify for ECMO. I’m at the age already that I’m too old. So it doesn’t matter if you’re rich or poor or friend of whoever. If you need that resource and there’s only six, we have to choose who that’s going to go to, that has the best chance of working,” Dr. Wilson said.

Dr. Wilson went on to explain the ECMO process.

We put a really large catheter about the size of your thumb through the large vein that goes down by the heart and into the lower, main vein and the whole body. What it does is that it bypasses the lungs. So we pull all the blood out, you put it through an oxygenator and you pull out the carbon dioxide and then the blood goes back in and then the heart circulates it. So it’s like being on heart bypass machine, but for an extended period of time.”

***This is part three in a multi-part series. You can watch and read part one, here, where we learned about the strain the COVID pandemic is having on West Virginia’s entire hospital system. In part two, we heard from many ICU workers about what it has been like working throughout the pandemic and what role staffing shortages are having on the situation. We’ll also hear from ICU doctors and nurses about the majority of their patients who are unvaccinated. Additional stories will be posted on this website and will air during West Virginia Tonight, during the week of Oct. 4, on WBOY(Clarksburg/Fairmont/Morgantown), WOWK(Charleston/Huntington), WTRF(Wheeling/Steubenville), WVNS(Beckley/Bluefield) and WDVM(Hagerstown/Martinsburg).

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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