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Pediatric ARDS: effect of supine-prone postural changes on oxygenation
Juan Casado-Flores1, Amelia Martínez de Azagra, Maria Jesús Ruiz-López
1Pediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Universidad Autonoma de Madrid, Avenida de Menéndez Pelayo 65, 28009 Madrid, Spain. jcasadof@line-pro.es
Intensive Care Medicine
|November 26, 2002
Summary
Repeatedly turning children with acute respiratory distress syndrome (ARDS) into the prone position improved their oxygenation. Non-responders to prone positioning had higher mortality rates, though not statistically significant.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Acute respiratory distress syndrome (ARDS) is a severe condition in children requiring intensive respiratory support.
- Prone positioning is a known intervention to improve oxygenation in ARDS, but its effect with repeated cycles in pediatric patients is less understood.
Purpose of the Study:
- To evaluate the impact of repeated supine-prone and prone-supine positioning on oxygenation in pediatric patients with severe ARDS.
- To identify potential differences in outcomes between responders and non-responders to prone positioning therapy.
Main Methods:
- A single-center prospective case series was conducted in a university pediatric intensive care unit.
- Twenty-three consecutive pediatric patients with severe ARDS (PaO(2)/FiO(2) <200) underwent repeated postural changes every 8 hours.
- Oxygenation (PaO(2)/FiO(2) ratio) was measured during supine-prone and prone-supine transitions, with responders defined by a >15% increase in the prone position.
Main Results:
- Eighteen of 23 patients (78%) were classified as responders, showing a significant increase in PaO(2)/FiO(2) ratio (22%, P <0.001) when placed in the prone position.
- Oxygenation decreased significantly (P = 0.011) when responders were returned to the supine position.
- The overall mortality rate was 48%, with higher mortality observed in non-responders (80%) compared to responders (39%), though this difference was not statistically significant (P = 0.95).
Conclusions:
- Repeated prone positioning effectively improves oxygenation in a substantial proportion of pediatric patients with ARDS.
- While not statistically significant, the trend suggests that non-response to prone positioning may be associated with increased mortality in this pediatric ARDS cohort.