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To the Editor: In their study of the effect of prone positioning in children with acute lung injury, Dr Curley and colleagues¹ found that prone positioning improved oxygenation index (OI) but did not affect duration of ventilation or mortality. In apparent contrast with this study, Trachsel et al² showed that OI is an independent predictor of mortality and is associated with duration of ventilation in children with acute hypoxemic respiratory failure. In that cohort, the mortality rate was higher than the 8% mortality reported by Curley et al and 46% of the deaths were attributable to refractory oxygenation failure. It is therefore possible that the negative results of the trial may be related to differences between these 2 populations. Moreover, the study by Relvas et al³ suggested that a more prolonged period in prone position can lead to more pronounced and stable improvement. It is possible that longer periods of . . . [Full Text of this Article]

Ricardo Garcia Branco, MD
brancori@terra.com.br
Paediatric Intensive Care Unit
Addenbrookes Hospital
Cambridge, England

Pedro Celiny Ramos Garcia, PhD
Paediatric Intensive Care Unit
Hospital São Lucas da Pontifícia Universidade Católica do Rio
Grande do Sul
Porto Alegre, Brazil

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