• Matthew K Leroue, Aline B Maddux, and Peter M Mourani.
• Section of Pediatric Critical Care, University of Colorado School of Medicine, Aurora, Colorado.
• Curr. Opin. Pediatr. 2021 Jun 1; 33 (3): 319-324.

Purpose Of ReviewAcute respiratory distress syndrome (ARDS) is a common manifestation of severe COVID-19. Prone positioning has been used successfully in adult patients with ARDS and has been shown to decrease mortality. The efficacy of prone positioning in pediatric ARDS is less clear. In this review, we discuss the physiologic principles and literature on prone positioning in adults and children relative to COVID-19.Recent FindingsThere are limited published data on prone positioning in respiratory failure because of COVID-19. The use of proning in nonintubated patients with COVID-19 may improve oxygenation and dyspnea but has not been associated with improved outcomes. Initial adult cohort studies of intubated patients undergoing prone positioning in severe ARDS related to COVID-19 have shown an improvement in mortality. Although the use of proning in children with severe COVID-19 is recommended, data supporting its use is scarce.SummaryAdditional studies to evaluate the efficacy of prone positioning in pediatric ARDS are needed to provide evidence for or against this treatment strategy in children. Given the unknown evolution of this pandemic, collaborative research efforts across pediatric centers provides the greatest opportunity to develop a data driven-approach to make use of this potential therapy.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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