• Juan Casado-Flores, Amelia Martínez de Azagra, Maria Jesús Ruiz-López, Miguel Ruiz, and Ana Serrano.
• Pediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Universidad Autonoma de Madrid, Avenida de Menéndez Pelayo 65, 28009 Madrid, Spain. jcasadof@line-pro.es
• Intensive Care Med. 2002 Dec 1;28(12):1792-6.

ObjectiveTo determine the effect of repeated prone positioning (supine-prone/prone-supine) on oxygenation in children suffering from ARDS.DesignSingle-center prospective case series.SettingUniversity pediatric ICU.PatientsConsecutive pediatric patients with severe ARDS (PaO(2)/FiO(2) <200, Murray score >2.5).InterventionsPatients were treated as soon as possible with supine-prone/prone-supine positioning every 8 h until clinical improvement or death occurred.Measurements And ResultsTwenty-three patients who had ARDS (0.5-months to 12.6-years-old), were placed in the prone position within 56+/-109 h after the diagnosis of ARDS. Prone-supine/supine-prone postural changes were repeated every 8 h for 9.7+/-5.5 days. Changes in PaO(2)/FiO(2) ratio during supine-prone and prone-supine positioning were evaluated. A positive change was defined as an increase of 15% of baseline value. The patient was classified as a responder when the mean increase in the prone position was greater than 15%. There were 18 responders and five non-responders. The responders showed an increase in PaO(2)/FiO(2) ratio of 22%, from 91+/-33 to 112+/-43 (P <0.001), when they were placed from the supine to the prone position. Their PaO(2)/FiO(2) ratio dropped from 109+/- 37 to 94 +/-36, P = 0.011, when changed from the prone to supine position. The overall mortality rate in this series was 48% (11 patients), which was higher in the non-responders (80%) than in the responders (39%), although this difference was not statistically significant (P = 0.95).ConclusionsThe prone position improves oxygenation in a significant proportion of children with ARDS. Although no statistically significant difference was found for the mortality rate, it was higher for the non-responders (80%) vs the responders (39%).

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