Pediatric ARDS: effect of supine-prone postural changes on oxygenation.
OBJECTIVE
To determine the effect of repeated prone positioning (supine-prone/prone-supine) on oxygenation in children suffering from ARDS.


METHODS
Single-center prospective case series.


METHODS
University pediatric ICU.


METHODS
Consecutive pediatric patients with severe ARDS (PaO(2)/FiO(2) <200, Murray score >2.5).


METHODS
Patients were treated as soon as possible with supine-prone/prone-supine positioning every 8 h until clinical improvement or death occurred.


RESULTS
Twenty-three patients who had ARDS (0.5-months to 12.6-years-old), were placed in the prone position within 56+/-109 h after the diagnosis of ARDS. Prone-supine/supine-prone postural changes were repeated every 8 h for 9.7+/-5.5 days. Changes in PaO(2)/FiO(2) ratio during supine-prone and prone-supine positioning were evaluated. A positive change was defined as an increase of 15% of baseline value. The patient was classified as a responder when the mean increase in the prone position was greater than 15%. There were 18 responders and five non-responders. The responders showed an increase in PaO(2)/FiO(2) ratio of 22%, from 91+/-33 to 112+/-43 (P <0.001), when they were placed from the supine to the prone position. Their PaO(2)/FiO(2) ratio dropped from 109+/- 37 to 94 +/-36, P = 0.011, when changed from the prone to supine position. The overall mortality rate in this series was 48% (11 patients), which was higher in the non-responders (80%) than in the responders (39%), although this difference was not statistically significant (P = 0.95).


CONCLUSIONS
The prone position improves oxygenation in a significant proportion of children with ARDS. Although no statistically significant difference was found for the mortality rate, it was higher for the non-responders (80%) vs the responders (39%).
Casado-Flores
Juan
J
Pediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Universidad Autonoma de Madrid, Avenida de Menéndez Pelayo 65, 28009 Madrid, Spain. jcasadof@line-pro.es
Martínez de Azagra
Amelia
A
Ruiz-López
Maria Jesús
MJ
Ruiz
Miguel
M
Serrano
Ana
A
D000208:Acute Disease; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D016684:Prone Position; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016683:Supine Position; D016896:Treatment Outcome
D010100:Oxygen