ReviewFrontiers in pediatrics2025
Prone positioning in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials.
Review in Frontiers in pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
3 authors.
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Abstract
Introduction: Acute respiratory distress syndrome (ARDS) in children, characterized by acute lung inflammation and impaired gas exchange, presents unique therapeutic challenges due to developmental differences in respiratory physiology. While prone positioning is established in adult ARDS management, its efficacy in pediatric populations remains debated. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating prone vs. supine ventilation in children and adolescents (0-18 years) with ARDS. Databases including PubMed, MEDLINE, Embase, CINAHL and CENTRAL were searched up to October 29, 2025. Methodological quality was assessed using the Cochrane risk-of-bias tool, and statistical synthesis was performed in R. Results: Thirteen RCTs (1,529 patients) were included. A meta-analysis of ten trials demonstrated a lower risk of death with prone compared with supine ventilation [risk ratio (RR) 0.67, 95% confidence interval (CI) 0.57-0.79; Conclusion: Prone positioning may reduce mortality and improve oxygenation in pediatric ARDS, but does not clearly shorten mechanical ventilation duration or ICU stay. These potential benefits support considering prone positioning as an adjunctive strategy in pediatric critical care protocols, while underscoring the need for larger, high-quality RCTs to refine patient selection and optimize implementation strategies.
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