Study objective: To compare the effect of the prone
position (PP) vs supine position (SP) on oxygenation in children with
acute respiratory failure (ARF).
randomized controlled trial.
Setting: A 36-bed
pediatric critical-care unit in a tertiary-care, university-based
Patients: Ten children (mean[
SD] age, 5 ± 3.6 years) with ARF with a baseline oxygenation
index (OI) of 22 ± 8.5.
Following a period of stabilization in the SP, baseline data were
collected and patients were randomized to one of two groups in a
two-crossover study design: group 1, supine/prone sequence; group 2,
prone/supine sequence. Each position was maintained for 12 h. Lung
mechanics and acute response to inhaled nitric oxide were examined in
Measurements and main results: OI was
significantly better in the PP compared to the SP over the 12-h period
(analysis of variance, p = 0.0016). When patients were prone, a
significant improvement in OI was detected (7.9 ± 5.3; p = 0.002);
this improvement occurred early (within 2 h in 9 of 10 patients)
and was sustained over the 12-h study period. Static respiratory system
compliance and resistance were not significantly affected by the
position change. Inhaled nitric oxide had no effect on oxygenation in
either position. Urine output increased while prone, resulting in a
significantly improved fluid balance (+ 6.6 ± 15.2 mL/kg/12 h in PP
vs + 18.9 ± 13.6 mL/kg/12 h in SP; p = 0.041). No serious adverse
effects were detected in the PP.
children with ARF, oxygenation is significantly superior in the PP than
in the SP. This improvement occurs early, remains sustained for a 12-h
period, and is independent of changes in lung