title: Prone equals prone? Impact of positioning techniques on respiratory function in anesthetized and paralyzed healthy children.
abstract: 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.
authors.affiliation: Division of Anesthesia, University Children's Hospital, Roemergasse 8, 4005, Basel, Switzerland. bvonungern@uhbs.ch
authors.forename: Britta S
authors.initials: BS
authors.lastname: von Ungern-Sternberg
authors.forename: Jürg
authors.initials: J
authors.lastname: Hammer
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Frei
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Jordi Ritz
authors.forename: Andreas
authors.initials: A
authors.lastname: Schibler
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Erb
mesh_terms: 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