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In Reply: Drs Branco and Garcia suggest that the prone position should be evaluated further in children with acute lung injury despite the negative results of our randomized clinical trial. It is true that there was an improvement in the OI in our study in patients treated with prone positioning, but this was not associated with an improvement in the duration of ventilation or mortality. Several clinical studies have shown that an improvement in oxygenation does not necessarily correlate with improvements in clinical outcomes.^1-3

Clinical trials and observational studies may differ in their conclusions for the reasons that Branco and Garcia cite, but there may be additional bias introduced in observational studies that may be difficult to identify. The inclusion and exclusion criteria in our trial were clearly defined. Of note, we excluded all patients who could not be safely treated in the prone position as well as patients who . . . [Full Text of this Article]

Martha A. Q. Curley, RN, PhD
martha.curley@childrens.harvard.edu
Department of Critical Care and Cardiovascular Nursing
Childrens Hospital Boston
Boston, Mass

Patricia L. Hibberd, MD, PhD
Tufts-New England Medical Center
Boston, Mass

Frederick E. Barr, MD, MS
Vanderbilt Children’s Hospital
Nashville, Tenn

Natalie Z. Cvijanovich, MD
Children’s Hospital Oakland
Oakland, Calif

Michael A. Matthay, MD
University of California
San Francisco

John H. Arnold, MD
Childrens Hospital Boston
Boston, Mass

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