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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

Published on: November 30, 2022

Prone Positioning in Infants With Acute Bronchiolitis: The PROPOSITIS Randomized Clinical Trial

Florent Baudin1,2, Robin Pouyau1, Fabien Subtil3,4

  • 1Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Urgences et de Réanimation Pédiatriques, Bron, France.

JAMA
|June 17, 2026
PubMed

Insights

Prone positioning did not significantly reduce the need for ventilation escalation in infants with bronchiolitis on high-flow nasal cannula support. Further research is needed to confirm these findings in pediatric respiratory care.

Area of Science:

  • Pediatric critical care medicine
  • Neonatology
  • Respiratory medicine

Background:

  • Prone positioning improves respiratory mechanics and oxygenation.
  • Its benefit in infants with acute viral bronchiolitis receiving high-flow nasal cannula (HFNC) support is unknown.

Purpose of the Study:

  • To investigate if prone positioning reduces the need for ventilation escalation in infants with moderate to severe acute bronchiolitis on HFNC support.

Main Methods:

  • Multicenter, randomized, open-label trial in pediatric intensive care units.
  • Infants (≤6 months) with moderate to severe bronchiolitis requiring HFNC were randomized to prone or supine positions.
  • Primary outcome: escalation to noninvasive or invasive ventilation within 72 hours.

Main Results:

  • No significant difference in ventilation escalation between prone (15.0%) and supine (20.8%) groups (aOR, 0.66; P=.09).
  • Secondary outcomes and safety profiles were similar between groups.
  • Study was not definitive due to a wide confidence interval.

Conclusions:

  • Prone positioning did not significantly reduce escalation of care in infants with bronchiolitis on HFNC.
  • Further research is warranted to definitively assess the clinical benefit.
Abstract

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