Abstract
BackgroundProne position ventilation is a widely used lung protection ventilation strategy. The strategy is more convenient to implement in children compared to adults. Due to the precise mechanism of improving oxygenation function, development of pediatric prone ventilation technology has been largely focused on children with acute respiratory distress syndrome. There is a paucity of high-quality studies investigating the effects of prone position ventilation after pediatric cardiac surgery. The purpose of this study is to evaluate the feasibility and effectiveness of prone position ventilation in infants who develop postoperative acute lung injury after surgery for congenital heart disease.MethodsA single-center, randomized controlled trial of pediatric patients with acute lung injury after surgery for congenital heart disease who will receive prone position ventilation or usual care (control group). A total of 68 children will be enrolled according to the inclusion criteria. The main outcome measures will be lung compliance and oxygenation index. The secondary outcomes will be duration of mechanical ventilation, length of stay in cardiac intensive care unit, reintubation rate, and complication rate.DiscussionThis study will investigate the feasibility and effectiveness of prone position ventilation techniques in children who develop postoperative acute lung injury after surgery for congenital heart disease. The results may help inform strategies to improve airway management after surgery for congenital heart disease.Trial registrationClinicalTrials.gov NCT04607993. Initially registered on 29 October 2020.
Highlights
Prone position ventilation is a widely used lung protection ventilation strategy
Pediatric acute lung injury (PALI) is a common complication of congenital heart disease that presents with refractory hypoxemia
Most data regarding management in children are extrapolated from clinical trials conducted in adults or neonates
Summary
Prone position ventilation is a widely used lung protection ventilation strategy. The strategy is more convenient to implement in children compared to adults. Due to the precise mechanism of improving oxygenation function, development of pediatric prone ventilation technology has been largely focused on children with acute respiratory distress syndrome. There is a paucity of high-quality studies investigating the effects of prone position ventilation after pediatric cardiac surgery. The purpose of this study is to evaluate the feasibility and effectiveness of prone position ventilation in infants who develop postoperative acute lung injury after surgery for congenital heart disease. Prone position has been used to treat severe hypoxemia in patients with acute respiratory distress syndrome (ARDS) since the 1970s. According to a systematic review, use of the prone position during mechanical ventilation improved survival of patients with ARDS who received protective lung ventilation [1]. Pediatric acute lung injury (PALI) is a common complication of congenital heart disease that presents with refractory hypoxemia. Ill pediatric patients represent a special group, and postural therapy plays an important role in the management of airways of these patients
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