Prone equals prone? Impact of positioning techniques on respiratory function in anesthetized and paralyzed healthy children.
OBJECTIVE
Although the prone position is effectively used to improve oxygenation, its impact on functional residual capacity is controversial. Different techniques of body positioning might be an important confounding factor. The aim of this study was to determine the impact of two different prone positioning techniques on functional residual capacity and ventilation distribution in anesthetized, preschool-aged children.


METHODS
Functional residual capacity and lung clearance index, a measure of ventilation homogeneity, were calculated using a sulfur-hexafluoride multibreath washout technique. After intubation, measurements were taken in the supine position and, in random order, in the flat prone position and the augmented prone position (gel pads supporting the pelvis and the upper thorax).


METHODS
Pediatric anesthesia unit of university hospital.


METHODS
Thirty preschool children without cardiopulmonary disease undergoing elective surgery.


RESULTS
Mean (range) age was 48.5 (24-80) months, weight 17.2 (10.5-26.9) kg, functional residual capacity (mean +/- SD) 22.9+/- 6.2 ml.kg (-1) in the supine position and 23.3 +/- 5.6 ml.kg (-1) in the flat prone position, while lung clearance indices were 8.1 +/- 2.3 vs. 7.9 +/- 2.3, respectively. In contrast, functional residual capacity increased to 27.6 +/- 6.5 ml.kg (-1) (p< 0.001) in the augmented prone position while at the same time the lung clearance index decreased to 6.7 +/- 0.9 (p< 0.001).


CONCLUSIONS
Functional residual capacity and ventilation distribution were similar in the supine and flat prone positions, while these parameters improved significantly in the augmented prone position, suggesting that the technique of prone positioning has major implications for pulmonary function.
von Ungern-Sternberg
Britta S
BS
Division of Anesthesia, University Children's Hospital, Roemergasse 8, 4005, Basel, Switzerland. bvonungern@uhbs.ch
Hammer
Jürg
J
Frei
Franz J
FJ
Jordi Ritz
Eva-Maria
EM
Schibler
Andreas
A
Erb
Thomas O
TO
D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D016684:Prone Position; D012119:Respiration; D012129:Respiratory Function Tests; D016683:Supine Position