Proning and HFOV as strategies for lung recruitment in patients with PARDS: the current view across European paediatric intensive care units

Abstract Introduction In paediatric acute respiratory distress syndrome (PARDS), recruitment strategies such as prone positioning (PP) and high-frequency oscillatory ventilation (HFOV) may improve lung aeration and ventilation–perfusion matching. This survey aimed to describe current PP and HFOV practices across European paediatric intensive care units (PICUs). Methods Selected sections of a broader cross-sectional anonymous online survey were distributed to 276 European PICUs (May 2022–May 2023). One response per unit was allowed, targeting paediatric intensivists, nurses, and respiratory/physiotherapy staff. Results The response rate was 54.7% (151/276). Most respondents were from teaching hospitals (92.0%) and mixed medical–surgical PICUs (93.0%); 82.1% reported > 300 annual admissions, and 44.0% were extracorporeal membrane oxygenation (ECMO) centres. PP and HFOV were used by 96.0% and 72.0% of units, respectively, with 68.5% employing both. Use of PP or HFOV was not associated with hospital type, ECMO availability, or nurse-to-patient ratios. PP was more frequent in centres with larger bed capacity (11.0 vs. 7.0; p = 0.04). HFOV use was more common in units with respiratory therapists/physiotherapists (81.0% vs. 67.0%; p = 0.014) and in higher-volume PICUs ( p = 0.018). PP was initiated within 48 h in 88.3% and applied for 12–24 h cycles in 57.2%. Spinal instability and polytrauma were common contraindications; facial oedema and device displacement frequent complications. HFOV was mainly used as rescue therapy. LRMs were applied in 79.0% after PP and 81.0% during HFOV. Conclusions This first survey of PP and HFOV use in European PICUs shows widespread adoption but considerable variation, underscoring the need for paediatric-specific research to guide individualized care.