The edition · Paediatrics
Neither prone positioning nor oscillation shortened ventilation in paediatric ARDS
A large factorial trial finds no first-line role for two common rescue strategies, a nurse-led asthma score handles children on oxygen, and family-based treatment adds to primary care obesity management.
The edition in brief
PROSpect (Lancet, 31 October) randomised 424 children with early moderate-to-severe paediatric ARDS in 75 intensive care units to prone or supine positioning and to high-frequency oscillatory or conventional ventilation. It stopped early for futility: ventilator-free days did not differ for either comparison, and 28-day mortality was 10% overall. Prone positioning brought more airway blockage and pressure injuries; oscillation brought more haemodynamic instability. A Dutch non-inferiority trial of 132 children admitted with acute wheeze needing oxygen (PLOS One, 30 October) found a nurse-led asthma score adapted for oxygen kept length of stay the same while cutting bronchodilator doses by a quarter. TEAM UP (JAMA Pediatrics, 1 October), a pragmatic trial in 41 US primary care practices with 730 children aged 6 to 15, found adding family-based behavioural treatment to enhanced primary care lowered percent median BMI by a further 3.8 units at 12 months. The pearl covers spacers in acute wheeze.
Prone positioning and oscillatory ventilation did not add ventilator-free days in paediatric ARDS
Use conventional ventilation in the supine position as the default for early paediatric ARDS; prone and HFOV added harms, not benefit.
A nurse-led asthma score for children on oxygen cut bronchodilator doses without lengthening stay
Consider a nurse-led, score-based protocol for wheezy children on oxygen to space bronchodilators safely.
A spacer works as well as a nebuliser in most acute wheeze
Give salbutamol by spacer in mild to moderate childhood wheeze and teach the technique before the child goes home.
Family-based behavioural treatment added to primary care lowered children's relative BMI
Treat childhood obesity with the family, using a structured behavioural programme alongside primary care follow-up.
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