Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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 prone position might have had a better effect on outcome.
Branco RG, Garcia PCR. Prone Positioning in Children With Acute Lung Injury. JAMA. 2005;294(18):2297-2298. doi:10.1001/jama.294.18.2297-a