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Prone Versus Supine
Position in Artificially Ventilated Neonates
El-Mashad AM (1), Hekal K.A.(2) , Adly M.
(2) & Salama E.R.(2)
Departments of Pediatrics (1) & Anesthesia(2),
Faculty of Medicine, Tanta University, Egypt
Tanta Med. Sc. J 2008; 3(4):47-61
Article type: Original article
Background/Aim: Changes in body position can significantly improve
gas exchange with few complications related to the maneuver. This
may result in a shorter stay in the critical care unit and improved
outcome for the critically ill patient. Patients & Methods: This
study was carried out on 60 neonates (39 females, 21 males) admitted
to the neonatal intensive care unite, Tanta University Hospital. All
neonates were suffering from respiratory failure and requiring
intubation and mechanical ventilation. Patients were classified into
four groups. Group Ia includes 15 neonates who were ventilated by
PCV mode in the prone position. Group Ib includes 15 neonates who
were ventilated by PCV mode in the supine position. Group IIa
includes 15 neonates who were ventilated by SIMV mode in the prone
position. Group IIb includes 15 neonates who were ventilated by SIMV
mode in the supine position. In group Ia & IIa, parameters were
measured during supine position before turning infants to the prone
position (baseline) and then they were turned prone and parameters
were measured after 1hour. Infants remained in the prone position
for 20 hours and parameters were measured again and after those
infants returned to the supine position and parameters were measured
after 1 hour. In group Ib & IIb, parameters were measured at
baseline after 1 hour, 20 hours and 21 hours. Results: The results
of our study showed that there was a significant increase in tidal
volume in group IIa when compared to group IIb at 1 hour and 20
hours after turning infants to the prone position but there was no
significant difference after returning to the supine position. Also
there was a significant decrease in mean airway pressure in group Ia
and IIa when compared to group Ib and IIb respectively after 20
hours of the prone position and also after returning to the supine
position. The results of our study also showed a significant
improvement in PaO2/FiO2 ratio and SpO2 after turning infants to the
prone position and also after returning to the supine position when
compared to the base line data. When comparing short duration of
prone position to long duration there were also a significant
improvement in PaO2/FiO2 and SpO2 with longer duration of the prone
position. When comparing group Ia and IIa to Ib and IIb
respectively, PaO2/FiO2 ratio and SpO2 were significantly higher in
group Ia and IIa. When comparing group Ia to IIa, PaO2/FiO2 ratio
and SpO2 were significantly higher in group IIa. Our results
revealed that the oxygenation index was significantly lower (better
oxygenation) after turning infants to the prone position and also
after returning to the supine position when compared to the base
line data. When comparing short duration of prone position to long
duration there were also a significant decrease in oxygenation index
with longer duration of the prone position. When comparing group Ia
and IIa to Ib and IIb respectively, the oxygenation index was
significantly lower in group Ia and IIa. When comparing group Ia to
IIa, the oxygenation index was significantly lower in group IIa. But
there were no significant changes in PH, PaCO2, HCO3, minute volume,
heart rate and mean arterial blood pressure either within the same
group or when comparing the groups with each other. Conclusion:
Prone positioning can be accomplished safely and it should be done
early in critically ill neonates with respiratory failure. Prone
positioning for long periods (20hours/day) have a cumulative and
persistent improvement in oxygenation with less airway pressure even
after return to the supine position
ICID 881849 |