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Prone versus supine position in mechanically ventilated children: a pilot study
Ashu Sawhney1, Nirmal Kumar, Vishnubhatla Sreenivas
1Department of Pediatrics, St. Stephen's Hospital, Tis Hazari Delhi, India.
Summary
Prone positioning during mechanical ventilation improves oxygenation and may reduce mortality in critically ill children. This study found better gas exchange and lower mortality rates when children were ventilated in the prone position.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Mechanically ventilated patients in the prone position show improved oxygenation compared to the supine position.
- The effect of prone positioning on survival in critically ill children requires further investigation.
Purpose of the Study:
- To evaluate the impact of prone positioning during mechanical ventilation on survival rates in critically ill children.
Main Methods:
- A prospective, randomized, controlled trial involving 42 children requiring mechanical ventilation.
- Children were randomized to initial ventilation in either prone or supine position for four hours, followed by a one-hour crossover to the alternate position.
- Oxygenation parameters, mean airway pressures, and mortality were compared between the groups.
Main Results:
- Mortality was lower in the prone group (odds ratio 0.20).
- The oxygenation index was significantly lower in the prone group at one, four, and five hours.
- Duration of ventilation was similar between the prone and supine groups.
Conclusions:
- Prone positioning in the initial hours of mechanical ventilation significantly enhances gas exchange and oxygenation in children.
- Prone ventilation reduces the mean airway pressures needed for ventilation and may improve survival rates.
- The study allowed for ventilator setting adjustments during the ventilation period.