The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Abstract

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

Keywords: Intensive care units; acute respiratory distress syndrome; artificial respiration; critical illness; pediatrics; prone position.

Figure 1

Oxygenation Index trends while proned displayed by individual patient. Figure Legend: Demonstration of oxygenation index trends prior to prone positioning and then at 6 h time epochs up to 48 h. If an oxygenation index was not available, then the oxygenation saturation index was back transformed into oxygenation index as was done by Khemani et al. [19]. Each line represents a different patient in this case series.

Figure 2

Oxygenation Index Trends After Starting Rotational Bed Therapy. Figure Legend: Comparison of oxygenation index trends prior to prone positioning and then after at 6 h intervals for the first 48 h. After prone positioning oxygenation indices improved over time. Oxygenation indices reported as medians, IQR, and ranges for each period examined. * = p-value < 0.05, ** = p-value < 0.01, *** = p-value < 0.001.