Related Experiment Videos
4A randomized trial of prolonged prone positioning in children with acute respiratory failure
A Kornecki1, H Frndova, A L Coates
1Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
The prone position significantly improves oxygenation in children with acute respiratory failure. This benefit is observed early and sustained, offering a safe and effective intervention.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Clinical Trials
Background:
- Acute respiratory failure (ARF) in children presents significant management challenges.
- Optimizing oxygenation is crucial for improving outcomes in pediatric ARF.
- The effect of body positioning on gas exchange in pediatric ARF requires further investigation.
Purpose of the Study:
- To compare the efficacy of the prone position (PP) versus the supine position (SP) in enhancing oxygenation for pediatric patients experiencing acute respiratory failure.
- To evaluate the impact of prone positioning on oxygenation index (OI) and other respiratory parameters in children with ARF.
Main Methods:
- A prospective, randomized controlled trial was conducted in a pediatric critical-care unit.
- Ten children with ARF were enrolled, with a mean age of 5 years.
- A two-crossover design was employed, with patients spending 12 hours in each position (supine/prone or prone/supine).
Main Results:
- Oxygenation index (OI) was significantly improved in the prone position compared to the supine position (p = 0.0016).
- Improvement in OI was noted early (within 2 hours) and sustained throughout the 12-hour prone period.
- No significant changes in lung mechanics were observed, and inhaled nitric oxide did not affect oxygenation.
Conclusions:
- The prone position offers a significant and sustained improvement in oxygenation for children with acute respiratory failure.
- Prone positioning is an effective strategy for enhancing gas exchange in pediatric ARF, independent of lung mechanics.
- The prone position is a safe intervention with no serious adverse effects noted in this study.
Study Objective:
To compare the effect of the prone position (PP) vs supine position (SP) on oxygenation in children with acute respiratory failure (ARF).
Design:
Prospective, randomized controlled trial.
Setting:
A 36-bed pediatric critical-care unit in a tertiary-care, university-based children's hospital.
Patients:
Ten children (mean [SD] age, 5 +/- 3.6 years) with ARF with a baseline oxygenation index (OI) of 22 +/- 8.5.
Interventions:
Following a period of stabilization in the SP, baseline data were collected and patients were randomized to one of two groups in a two-crossover study design: group 1, supine/prone sequence; group 2, prone/supine sequence. Each position was maintained for 12 h. Lung mechanics and acute response to inhaled nitric oxide were examined in each position.
Measurements And Main Results:
OI was significantly better in the PP compared to the SP over the 12-h period (analysis of variance, p = 0.0016). When patients were prone, a significant improvement in OI was detected (7.9 +/- 5.3; p = 0.002); this improvement occurred early (within 2 h in 9 of 10 patients) and was sustained over the 12-h study period. Static respiratory system compliance and resistance were not significantly affected by the position change. Inhaled nitric oxide had no effect on oxygenation in either position. Urine output increased while prone, resulting in a significantly improved fluid balance (+ 6.6 +/- 15.2 mL/kg/12 h in PP vs + 18.9 +/- 13.6 mL/kg/12 h in SP; p = 0.041). No serious adverse effects were detected in the PP.
Conclusion:
In children with ARF, oxygenation is significantly superior in the PP than in the SP. This improvement occurs early, remains sustained for a 12-h period, and is independent of changes in lung mechanics.