Prone versus supine position in mechanically ventilated children: a pilot study.
BACKGROUND
It is known that mechanically ventilated patients in the prone position have improved oxygenation compared with those supine. We did a prospective, randomized, controlled trial to evaluate the effect of prone position during mechanical ventilation, on survival in critically ill children.


METHODS
Forty-two children needing mechanical ventilation for various illnesses were randomized to receive initial ventilation for four hours prone or supine by drawing lots. Initial severity of illness and blood gases in all children were noted. In a crossover design, after the initial four hours the children were turned over and ventilated in the alternate posture for an hour. Oxygenation parameters and mean airway pressures were noted at one hour, four hours, and five hours. Mortality, duration of ventilation, and the above parameters were compared in the two groups.


RESULTS
Initial PRISM scores were similar in the two groups. Mortality in the prone group was less than in the supine group. The odds ratio of mortality was 0.20 (95% CI 0.05-0.75). Duration of ventilation was similar in the two groups. The oxygenation index was significantly lower in the prone group at one, four, and five hours after onset of ventilation.


CONCLUSIONS
Prone position in the first few hours of ventilation significantly improves gas exchange and oxygenation, reduces the mean airway pressures required to ventilate children, and may cause significant improvement in survival. Our study protocol allowed ventilator settings to be changed as needed during ventilation.
Sawhney
Ashu
A
Department of Pediatrics, St. Stephen's Hospital, Tis Hazari Delhi, India.
Kumar
Nirmal
N
Sreenivas
Vishnubhatla
V
Gupta
Sangeeta
S
Tyagi
Vineet
V
Puliyel
Jacob M
JM
D002675:Child, Preschool; D018592:Cross-Over Studies; D006801:Humans; D007223:Infant; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D016684:Prone Position; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality; D015656:Respiratory Mechanics; D016683:Supine Position; D013997:Time Factors
D010100:Oxygen