Related Experiment Video
Updated: Aug 18, 2026
An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
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.
Insights
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.
Background:
It is known that mechanically ventilated patients in the prone position have improved oxygenation compared with those supine. We did a prospective, randomized, controlled trial to evaluate the effect of prone position during mechanical ventilation, on survival in critically ill children.
Material/Methods:
Forty-two children needing mechanical ventilation for various illnesses were randomized to receive initial ventilation for four hours prone or supine by drawing lots. Initial severity of illness and blood gases in all children were noted. In a crossover design, after the initial four hours the children were turned over and ventilated in the alternate posture for an hour. Oxygenation parameters and mean airway pressures were noted at one hour, four hours, and five hours. Mortality, duration of ventilation, and the above parameters were compared in the two groups.
Results:
Initial PRISM scores were similar in the two groups. Mortality in the prone group was less than in the supine group. The odds ratio of mortality was 0.20 (95% CI 0.05-0.75). Duration of ventilation was similar in the two groups. The oxygenation index was significantly lower in the prone group at one, four, and five hours after onset of ventilation.
Conclusions:
Prone position in the first few hours of ventilation significantly improves gas exchange and oxygenation, reduces the mean airway pressures required to ventilate children, and may cause significant improvement in survival. Our study protocol allowed ventilator settings to be changed as needed during ventilation.
Related Concept Videos
01:29Mechanical Ventilation I: Indication and Settings
01:11Anatomical Positions
The body is upright, facing forward, and standing erect.
The feet are parallel and flat on the floor.
The arms are hanging by the...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation: