Ventilation in prone position in a 5-year-old traumatized child. Effectivetreatment of persistent atelectasis

We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib frac tures, rupture of liver and spleen). Under continuous analgosedation, the y oung patient was ventilated in prone position for 6 h, since acute lung inj ury and atelectasis persisted despite various therapeutic measures (artific ial ventilation in the pressure controlled mode,fiberoptic bronchoscopy, re expansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation,which persisted in the following per iod. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically a fter supine repositioning. After cessation of analgosedation, the extubatio n was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapi dly. Although there is a lack of experience with ventilation in prone position i n pediatric intensive care, our report might be a recommendation for the in dication of this technique in children.