The Role of Prone Position Combined With Nasal CPAP in Preventing Extubation Failure in Infants After Cardiac Surgery.

BACKGROUND: Previous studies suggest that prone position could improve oxygenation and prevent lung injury. Whether prone position can improve post-extubation clinical outcomes in infants undergoing cardiac surgery is unknown. The aim of our study was to investigate the effects of prone position in preventing extubation failure in noninvasively ventilated infants after cardiac surgery. METHODS: Ninety-six infants who were weaned to nasal CPAP after congenital cardiac surgery were randomly divided into 2 groups: the prone position group (n 5 48) and the supine position group (n 5 48). Primary outcomes measured were extubation failure rate within 48 h of extubation and arterial blood gas values within 6 h of a mandatory prone positioning session. Secondary outcomes included nasal trauma, pressure ulcers, pneumothorax, gastroesophageal reflux, abdominal distention, in-hospital mortality, postoperative nasal CPAP duration, and hospital length of stay. RESULTS: Compared with the supine position group, the prone position group had fewer extubation failure infants (2.0% vs 14.5%, P = .02). Arterial blood gas values after 6 h after a mandatory prone positioning session showed that the PaO2 and P_aO2/F_IO2 in the prone position group were significantly higher than those in the supine position group (P_aO2 93.3 ± 8.5 vs 82.5 ± 9.1, P < .05; P_aO2/F_IO2 255.8 ± 23.6 vs 235.8 ± 20.7, P < .05). Moreover, nasal CPAP duration and total hospital length of stay in the prone position group were significantly shorter than those in the supine position group (P < .05). CONCLUSIONS: In infants supported with nasal CPAP following cardiac surgery, prone positioning improved postextubation oxygenation, helped reduced extubation failure, and reduced the duration of nasal CPAP ventilation and total hospital length of stay. [ABSTRACT FROM AUTHOR]