Prone positioning in pediatric acute respiratory distress syndrome failure (neonate excluded): a narrative review

Abstract

Prone positioning is an increasing practice in the management of acute respiratory distress in children. Indeed, despite the lack of positive studies evaluating the efficacy of this postural treatment in the pediatric population; the publication of several adult studies highlighting an improvement of the outcome of patients with respiratory distress syndrome, who have benefited from prolonged prone decubitus run, has largely promoted the use of this practice in children. However, children's respiratory physiology differs strongly to that of adults. Moreover, this function evolves over time to get closer to that of the adult. As a result, the use of the prone position may not have the same effects as in the adult population depending on the age of the children. Indeed, even if its implementation is simple and carries little risk, the absence of a positive paediatric study may raise questions about its effectiveness. The objective of this review is to provide an overview of the physiological and clinical studies that have been conducted in the paediatric population, drawing a parallel with adult data.