Abstract
Objective. To determine the effect of repeated prone positioning (supine-prone/prone-supine) on oxygenation in children suffering from ARDS.
Design. Single-center prospective case series.
Setting. University pediatric ICU.
Patients. Consecutive pediatric patients with severe ARDS (PaO2/FiO2 <200, Murray score >2.5).
Interventions. Patients were treated as soon as possible with supine-prone/prone-supine positioning every 8 h until clinical improvement or death occurred.
Measurements and results. Twenty-three patients who had ARDS (0.5-months to 12.6-years-old), were placed in the prone position within 56±109 h after the diagnosis of ARDS. Prone-supine/supine-prone postural changes were repeated every 8 h for 9.7±5.5 days. Changes in PaO2/FiO2 ratio during supine-prone and prone-supine positioning were evaluated. A positive change was defined as an increase of 15% of baseline value. The patient was classified as a responder when the mean increase in the prone position was greater than 15%. There were 18 responders and five non-responders. The responders showed an increase in PaO2/FiO2 ratio of 22%, from 91±33 to 112±43 (P <0.001), when they were placed from the supine to the prone position. Their PaO2/FiO2 ratio dropped from 109± 37 to 94 ±36, P = 0.011, when changed from the prone to supine position. The overall mortality rate in this series was 48% (11 patients), which was higher in the non-responders (80%) than in the responders (39%), although this difference was not statistically significant (P = 0.95).
Conclusions. The prone position improves oxygenation in a significant proportion of children with ARDS. Although no statistically significant difference was found for the mortality rate, it was higher for the non-responders (80%) vs the responders (39%).
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Casado-Flores, J., de Azagra, A., Ruiz-López, M. et al. Pediatric ARDS: effect of supine-prone postural changes on oxygenation. Intensive Care Med 28, 1792–1796 (2002). https://doi.org/10.1007/s00134-002-1527-8
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DOI: https://doi.org/10.1007/s00134-002-1527-8