Fluid balance in pediatric patients in prone position: a pragmatic study

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Fluid Management in Critically Ill Patients

Background:

• Critically ill pediatric patients often require mechanical ventilation (MV) for pulmonary conditions.
• Prone positioning is a therapeutic maneuver used in some critically ill patients.
• The effects of prone positioning on fluid balance and diuresis in this population require clarification.

Purpose of the Study:

• To determine if prone positioning increases diuresis and decreases cumulative fluid balance in pediatric patients on MV.
• To identify any adverse events associated with prone positioning in this cohort.

Main Methods:

• Retrospective observational study of pediatric patients (1 month to 12 years) on MV for pulmonary causes.
• Comparison between a prone position group (PG) and a control group (CG).
• Longitudinal data analysis from Day 1 to Day 4, including diuresis, fluid balance, and diuretic use.

Main Results:

• No significant difference in overall diuresis or cumulative fluid balance between PG and CG.
• The prone position group showed higher diuresis and lower cumulative fluid balance on Day 2.
• Increased use of furosemide and spironolactone was noted in the prone position group.
• No increase in adverse events was observed during prone positioning.

Conclusions:

• Prone positioning was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients undergoing mechanical ventilation.
• The use of prone position did not lead to an increase in adverse events.
• Further research may explore specific patient subgroups or ventilation strategies.