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[Ventilation in prone position in a 5-year-old child after multiple trauma. Effective treatment of persistent
1Abteilung für Anästhesie und Intensivmedizin, Evangelisches Diakonissenkrankenhaus Karlsruhe.
Insights
Prone position ventilation improved oxygenation in a severely injured child with acute lung injury. This technique may be beneficial for pediatric intensive care patients with similar conditions.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Respiratory physiology
Background:
- Severe thoracic and abdominal injuries in children can lead to acute lung injury (ALI) and atelectasis.
- Conventional treatments like mechanical ventilation and bronchoscopy may not fully resolve respiratory compromise.
- The use of prone positioning in pediatric intensive care for ALI is not well-established.
Observation:
- A 5-year-old child with extensive trauma and persistent respiratory failure was placed in prone position.
- Ventilation in prone position was maintained for 6 hours under sedation.
- Hemodynamic stability was monitored throughout the procedure.
Findings:
- Prone positioning rapidly improved arterial oxygenation in the pediatric patient.
- Radiological imaging confirmed complete resolution of atelectasis after returning to supine position.
- No adverse effects on abdominal injuries or liver function were observed; liver function improved.
Implications:
- Prone position ventilation can be a safe and effective rescue therapy for pediatric patients with severe ALI and trauma.
- This case suggests that prone positioning should be considered in pediatric intensive care units for refractory respiratory failure.
- Further studies are warranted to establish guidelines for prone position ventilation in critically ill children.
Abstract:
We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgesic sedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artificial ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgesic sedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.