Routine Prone Positioning Shows No Gain for Children
A 424-child international trial found prone positioning and high-frequency oscillatory ventilation did not improve ventilator-free days in pediatric ARDS.
Updated on Nov. 6, 2026 in Children’s Health
The PROSpect trial, published in The Lancet, found that early routine prone positioning and high-frequency oscillatory ventilation did not increase ventilator-free days for children with pediatric acute respiratory distress syndrome. Researchers recommended de-implementing routine first-line use of both approaches in pediatric critical care protocols.
Why it matters
Both techniques are widely used in intensive care units treating critically ill children, so the findings challenge routine practice. The trial also linked prone positioning to higher rates of airway obstruction and pressure-related skin injuries, and HFOV to increased hemodynamic instability.
The international phase 3 randomised trial enrolled 424 children across 75 hospitals in 18 countries, finding no significant difference in ventilator-free days through day 28 for either intervention versus usual care. Overall 28-day mortality was 10%, with no significant differences between groups, and the extent of the adverse-event differences in the trial remains unspecified.
The players
Children's Hospital of Philadelphia
A major pediatric medical center in Philadelphia that is recognized for pediatric critical care and research, and whose researchers served as the lead senior authors of the PROSpect trial.
University of Pennsylvania
A private Ivy League research university in Philadelphia whose School of Nursing is credited as a source for the PROSpect trial work.
The details
Children were randomised to prone or supine positioning and to HFOV or conventional mechanical ventilation, compared against usual care. Prone positioning was associated with more airway obstruction and pressure-related skin injuries, while HFOV was associated with increased hemodynamic instability.
Timeline
Results of the PROSpect trial were reported in the news on November 6, 2026.
Big Picture
The PROSpect trial, published in The Lancet, tested two techniques that are common in pediatric intensive care and found neither improved ventilator-free days. Its authors' call to de-implement routine first-line use marks a shift away from applying these approaches by default in children with pediatric acute respiratory distress syndrome.
Parents of children with severe breathing failure may see different first-line treatments discussed in intensive care units, as routine use of prone positioning and HFOV is no longer supported by this trial. The trial also flagged airway obstruction, skin injuries, and blood-pressure instability as risks to weigh in any decision.
The takeaway
Routine use of prone positioning and HFOV should not be assumed to help children with pediatric ARDS, according to this trial. Clinicians and families may benefit from asking how each therapy's specific risks compare with the expected benefits for an individual child.
Further reading
Explore more in Children's Health for context on pediatric critical care research.
More information
Read the full PROSpect trial in The Lancet for the complete study results.
Source note: This article includes information reported by News-Medical.
