Is Prone Positioning Worth the Turn in Pediatrics? Unraveling the Oxygenation Mystery in Ventilated Patients with Acute Respiratory Distress Syndrome: An Observational Study Introducing a Novel SF Ratio Method for Non-Invasive Monitoring in Children

Background: Respiratory illnesses are prevalent among children, attributed to factors such as immature immune systems, anatomical variations, and increased susceptibility to infections. Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality, necessitating various forms of respiratory support in pediatric intensive care units (PICUs). Prone positioning has emerged as a strategy to improve oxygenation in ARDS, but its effectiveness and correlation with non-invasive monitoring parameters remain underexplored.

Subjects and Methods: This prospective observational study, conducted in the PICU of Dr. B.C Roy PGIPS, Kolkata, aimed to assess the impact of prone ventilation on oxygenation in children diagnosed with ARDS. The study, spanning 18 months, included 40 patients aged 3 months to 12 years requiring mechanical ventilation. Parameters such as oxygenation index (OI), oxygen saturation index (OSI), PF ratio, and SF ratio were monitored at different time points during supine and prone ventilation. Prone positioning's effectiveness was evaluated based on improvements in these parameters.

Results: The study revealed a significant improvement in oxygenation status after four hours of prone ventilation compared to supine ventilation. Oxygenation index, OSI, SF ratio, and PF ratio showed statistically significant changes favoring prone positioning. A strong positive correlation between SF ratio and PF ratio was observed at various time points, emphasizing the potential of SF ratio as a non-invasive alternative. Responders and non-responders to prone positioning were identified based on predefined criteria, highlighting individual variability in treatment response.

Conclusion: Prone ventilation demonstrated significant improvements in oxygenation parameters in children with ARDS. The study supports the use of non-invasive SF ratio as a reliable substitute for PF ratio, simplifying monitoring without invasive arterial sampling. This finding has implications for improving ARDS management strategies in pediatric patients, offering a less cumbersome alternative for assessing oxygenation status.