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Prone Positioning in Children With ARDS
Positive Reflections on a Negative Clinical Trial
Brian P. Kavanagh, MB, FRCPC
JAMA. 2005;294:248-250.
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Acute respiratory distress syndrome (ARDS) is common, highly lethal, and not curable. Although important adult ARDS studies1-2 continue to undergo reappraisal,3-4 promising data have recently been reported for treatment of this entity in children. A recent randomized controlled trial,5 which described a beneficial effect of surfactant, was the first report of an effective treatment for ARDS.
In this issue of JAMA, Curley and colleagues6 from the same research group, the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), report on the effect of prone positioning in children with ARDS; oxygenation was improved, yet outcomes were unchanged. Clinicians will reflect on these results and ask how to incorporate the findings from this valuable study into providing the best possible care for their patients.
Why would a clinician wish to turn a critically ill child upside down? More than 30 years ago, Bryan7 reasoned that the . . . [Full Text of this Article]
Author Affiliations: Departments of Critical Care Medicine, Anesthesia, and Physiology, Hospital for Sick Children, University of Toronto, Ontario.
RELATED ARTICLE
Effect of Prone Positioning on Clinical Outcomes in Children With Acute Lung Injury: A Randomized Controlled Trial
Martha A. Q. Curley, Patricia L. Hibberd, Lori D. Fineman, David Wypij, Mei-Chiung Shih, John E. Thompson, Mary Jo C. Grant, Frederick E. Barr, Natalie Z. Cvijanovich, Lauren Sorce, Peter M. Luckett, Michael A. Matthay, and John H. Arnold
JAMA. 2005;294(2):229-237.
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