Prone Positioning of Pediatric Patients With ARDS Results in Improvement in Oxygenation if Maintained> 12 h Daily*

Objectives: To evaluate changes in oxygenation index (OI) in pediatric patients with ARDS during the first 24 h of prone positioning (PP), and to determine whether or not longer periods of PP (> 12 h) result in a more pronounced improvement in oxygenation. Design: A retrospective chart review of patients with ARDS who had been placed in PP for their management. Setting: Pediatric ICU of a children’s hospital. Measurements and main results: We retrieved the charts of patients with ARDS who had been admitted to our pediatric ICU over a 3-year period and placed in PP for their management. The patients received mechanical ventilation, were sedated and pharmacologically paralyzed, and underwent arterial blood gas analysis, with concomitant documentation of ventilator settings, at a frequency of once every 4 h or more often. We divided the first 24 h of PP into two periods, brief and prolonged. The brief period was defined as duration of PP between 6 h and 10 h, and the prolonged period was between 18 h and 24 h. We compared pre-PP OI values to values after brief periods and prolonged periods of PP. Values of the PaO2/fraction of inspired oxygen (P/F) ratio and the mean airway pressure (MAP) were similarly evaluated. We also evaluated the degree of OI fluctuations during 24 h of PP b