Can positioning COVID-19 patients on their stomach lead to better outcomes?

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Original author: Ana Gajic

Published: July 15, 2020


A team of General Internal Medicine (GIM) physicians are investigating whether the simple step of positioning a COVID-19 patient on their stomach can decrease their risk of death and aid their recovery.

Dr. Fahad Razak

The trial, which includes 11 hospitals in Canada and the US, is being led by Dr. Michael Fralick at Mount Sinai Hospital and Dr. Amol Verma and Dr. Fahad Razak of St. Michael’s.

They want to know whether prone positioning – the practice of positioning a patient with COVID-19 on their stomach – helps lower the risk of death and need for mechanical ventilation or supplemental oxygen.

Dr. Michael Fralick

“Many health-care workers have anecdotally noted that flipping a COVID-19 patient to lie on their stomachs improves their oxygen levels,” said

Dr. Fralick, who is also a researcher at the Li Ka Shing Knowledge Institute (LKSKI).

“The study will aim to prove this anecdotal evidence. If a patient who has COVID-19 is hospitalized but they are not critically ill, they will be randomized to either spend time on their stomachs or to receive the standard of care.”

Dr. Travis Carpenter

“The team at St. Joseph’s has poured their heart and souls into finding the best possible treatments for patients during this pandemic,” said Dr. Travis Carpenter, a GIM Physician and the site study lead at St. Joseph’s. “For each site involved, the real benefit here is the opportunity to better understand how to provide the best care possible to COVID-19 patients.”

The mix of community hospitals and academic centres will make the study’s findings more applicable, Dr. Fralick said.

“While large research projects often originate from downtown hospitals, that’s not where we’ve seen the most COVID-19 patients,” he explained. “Hospitals in areas that have been hit hard by this pandemic will provide a crucial perspective to this work.”

At William Osler Health System (Osler), which has hospitals in Brampton and Etobicoke, study leads Dr. Karen Britto and Dr. Haseena Hussein say they are excited to be part of this work, especially given the hospital’s experience during the pandemic.

“Particularly relevant to COVID-19, we serve a population with high rates of diabetes, hypertension and heart disease, three chronic illnesses which we know worsen outcomes for COVID patients,” said Dr. Hussein, a GIM physician at Osler. “Brampton has seen a relatively higher incidence of the virus. Because of this, we feel it’s particularly important Osler is fully participating in research to try and find ways to help treat this virus.”

Dr. Amol Verma

The hope is to find ways to avoid mechanical ventilation for COVID-19 patients. If lying patients on their stomachs is found to be effective, it would alleviate pressure on resources and help patients get better faster as recovery after ventilation can be slow and difficult.

“This is a simple intervention that can have an impact and be modelled in lower income countries where access to mechanical ventilators may be limited,” said Dr. Verma, who is also a researcher at the LKSKI.

Dr. Karen Britto

For the researchers across the Greater Toronto Area, the collaboration has meant more access to research resources and knowledge across the system, and partnerships that will outlast the pandemic.

“What one hospital could not do alone, we all can hopefully do together,” said Dr. Britto, a hospitalist and emergency medicine physician at Osler. “This is the very definition of cooperation.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit