CARING FOR THE CRITICALLY ILL PATIENT EffectofPronePositioningonClinicalOutcomes in Children With Acute Lung Injury A Randomized Controlled Trial

ACUTE LUNG INJURY IS A MAJOR cause of acute respiratory failure in patients who are critically ill and is associated with several clinical disorders, including sepsis, pneumonia, and aspiration. Although lifesaving, traditional ventilation strategies with higher tidal volumes and airway pressures can exacerbate lung inflammation and injury. Acute lung injury produces parenchymal lung damage that is heterogeneous and may place the patient at risk for ventilatorassociated lung injury. When patients are supine, the reduced volume of the nondependent-aerated lung is at risk for alveolar overdistention, and the cyclical ventilation of the dependent lung at low volumes can cause recruitmentderecruitment with subsequent mechanical strain. Prone positioning, as