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Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial

Martha A Q Curley1, Patricia L Hibberd, Lori D Fineman

  • 1Children's Hospital Boston, Medical-Surgical Intensive Care Unit, 300 Longwood Ave, Boston, MA 02115, USA. martha.curley@childrens.harvard.edu

JAMA
|July 15, 2005
PubMed

Insights

Prone positioning did not improve clinical outcomes for pediatric acute lung injury patients. This study found no significant difference in ventilator-free days between prone and supine positioning.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Clinical Trials

Background:

  • Prone positioning has shown promise in improving oxygenation in pediatric acute lung injury (ALI) patients in uncontrolled studies.
  • However, its impact on clinical outcomes in children with ALI remains unknown.

Purpose of the Study:

  • To determine if prone positioning improves clinical outcomes in pediatric patients with acute lung injury.
  • The primary hypothesis was that prone positioning would lead to more ventilator-free days at 28 days compared to supine positioning.

Main Methods:

  • A multicenter, randomized, controlled trial involving 102 pediatric patients (2 weeks to 18 years) with ALI.
  • Patients were randomized to either supine or prone positioning, with the prone group positioned for 20 hours daily for up to 7 days.
  • Ventilator-free days to day 28 was the primary outcome measure.

Main Results:

  • The trial was stopped early due to futility.
  • No significant difference was observed in ventilator-free days between the prone and supine groups (15.6 vs 15.8 days).
  • Secondary outcomes, including mortality, recovery time, organ-failure-free days, and functional health, also showed no significant differences between groups.

Conclusions:

  • Prone positioning does not significantly reduce ventilator-free days in pediatric patients with acute lung injury.
  • The study concludes that prone positioning does not offer clinical outcome benefits for this patient population.
Abstract

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