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Anecdata: I distinctly remember spending a lot of time lying on my stomach in hospital beds during several stints of double pneumonia I experienced as a child,

by elric 7y ago

Anecdata: I distinctly remember spending a lot of time lying on my stomach in hospital beds during several stints of double pneumonia I experienced as a child, some 30 years ago. It's hard to imagine that front line doctors didn't know about proning a month ago. Is this a technique that went out of vogue since my childhood, only to be replaced with a reliance on sedation and ventilators, and is it making a comeback due to the lack of ventilators? Or it it because proning unconscious, intubated patients is hard work and requires three nurses? I can imagine that being difficult to do when your ICU is swamped. Here's what that looks like: https://www.youtube.com/watch?v=E_6jT9R7WJs https://www.youtube.com/watch?v=E_6jT9R7WJs

Scoundreller 7y ago
> Or it it because proning unconscious, intubated patients is hard work and requires three nurses? I think in this situation, it’s letting these patients be managed without sedation or intubation.
the_mitsuhiko 7y ago
> It's hard to imagine that front line doctors didn't know about proning a month ago. Where do you get the idea they didn’t?
- coldtea 7y ago
  Because there were several articles implying so... https://edition.cnn.com/2020/04/14/health/coronavirus-prone-positioning/index.html https://edition.cnn.com/2020/04/14/health/coronavirus-prone-...
kbenson 7y ago
> Is this a technique that went out of vogue since my childhood I think it's just as likely that maybe the knowledge is unevenly distributed, and if a doctor at the hospital is aware of it then it may spread, but may not spread beyond that hospital easily. It also may not spread until there are cases that benefit from it so other doctors can observe or hear about it. Just like in software engineering, there are things that are taught, and then there are things that are learned over time, imparted by a mentor, or spread through a group. Doctors seem to have a better handle on this, as they do residencies to learn a lot of the practical skills that are hard to teach in a classroom, but that does probably lead to those skills learned in residency being fairly variable.
andrewtbham 7y ago
The change is to delay putting people on the ventilator.
- andrewtbham 7y ago
  proning was recommend quite a while ago... i first heard about proning during the italian outbreak... the new change is to delay putting people on the ventilator... and when you do put them on the ventilator, you max oxygen and keep pressure low. this is not the typical way to treat ards.

by elric 7y ago

Scoundreller 7y ago

> Or it it because proning unconscious, intubated patients is hard work and requires three nurses? I think in this situation, it’s letting these patients be managed without sedation or intubation.

the_mitsuhiko 7y ago

> It's hard to imagine that front line doctors didn't know about proning a month ago. Where do you get the idea they didn’t?

coldtea 7y ago
Because there were several articles implying so... https://edition.cnn.com/2020/04/14/health/coronavirus-prone-positioning/index.html https://edition.cnn.com/2020/04/14/health/coronavirus-prone-...

kbenson 7y ago

> Is this a technique that went out of vogue since my childhood I think it's just as likely that maybe the knowledge is unevenly distributed, and if a doctor at the hospital is aware of it then it may spread, but may not spread beyond that hospital easily. It also may not spread until there are cases that benefit from it so other doctors can observe or hear about it. Just like in software engineering, there are things that are taught, and then there are things that are learned over time, imparted by a mentor, or spread through a group. Doctors seem to have a better handle on this, as they do residencies to learn a lot of the practical skills that are hard to teach in a classroom, but that does probably lead to those skills learned in residency being fairly variable.

andrewtbham 7y ago

The change is to delay putting people on the ventilator.

andrewtbham 7y ago
proning was recommend quite a while ago... i first heard about proning during the italian outbreak... the new change is to delay putting people on the ventilator... and when you do put them on the ventilator, you max oxygen and keep pressure low. this is not the typical way to treat ards.