No ventilator-free day benefit from prone positioning or HFOV in PARDS

The PROSpect trial, an international phase 3 factorial RCT, compared prone versus supine positioning and HFOV versus conventional mechanical ventilation in children with early moderate-to-severe pediatric ARDS, stopping early for futility and slow enrollment after 424 of 600 planned patients. The trial reported no significant differences in ventilator-free days through day 28 for either comparison, while prone positioning was associated with more airway obstruction and pressure injuries, and HFOV was associated with more hemodynamic instability. The authors state these findings do not support routine use of prone positioning or HFOV as first-line strategies in this population.

Most relevant for: Pediatric intensive care clinicians managing mechanically ventilated children with early moderate-to-severe acute respiratory distress syndrome.

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