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Prone positioning in children with respiratory failure because of coronavirus disease 2019

Matthew K Leroue1, Aline B Maddux1, Peter M Mourani2

  • 1Section of Pediatric Critical Care, University of Colorado School of Medicine, Aurora, Colorado.

Current Opinion in Pediatrics
|March 30, 2021
PubMed

Insights

Prone positioning may improve oxygenation in COVID-19 patients but lacks data in children. More research is needed to confirm its benefits for pediatric acute respiratory distress syndrome (ARDS).

Area of Science:

  • Critical Care Medicine
  • Pediatric Pulmonology
  • Infectious Diseases

Background:

  • Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19.
  • Prone positioning (placing patients on their stomach) is a known intervention for adult ARDS, improving outcomes and reducing mortality.
  • The effectiveness of prone positioning in pediatric ARDS, especially related to COVID-19, remains uncertain.

Purpose of the Study:

  • To review the physiological principles of prone positioning.
  • To discuss existing literature on prone positioning in both adult and pediatric ARDS, with a focus on COVID-19.
  • To highlight the need for further research in pediatric populations.

Main Methods:

  • Literature review of studies on prone positioning in ARDS.
  • Analysis of data concerning COVID-19 patients, both adults and children.
  • Discussion of physiological mechanisms and clinical evidence.

Main Results:

  • Limited data exists on prone positioning for COVID-19-related respiratory failure.
  • In non-intubated COVID-19 patients, proning may alleviate symptoms but hasn't improved outcomes.
  • Adult studies show reduced mortality in severe COVID-19 ARDS with prone positioning; pediatric data is scarce despite recommendations.

Conclusions:

  • Further studies are essential to establish the efficacy of prone positioning in pediatric ARDS.
  • Collaborative research across pediatric centers is crucial for a data-driven approach to this therapy.
  • Evidence is needed to support or refute the use of prone positioning in children with severe COVID-19.
Abstract

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