HFOV with prone ventilation in pediatric severe ARDS, a case series from a tertiary care hospital

Severe ARDS in pediatrics is a life-threatening illness associated with significant morbidity and mortality, which often needs use of rescue ventilatory and non-ventilatory strategies. Despite non-encouraging results of HFOV in adults, its use still continues in pediatric population. We present three cases of primary severe ARDS, where oxygenation was refractory to conventional ventilation, prone positioning with conventional ventilation and to HFOV ventilation in supine position. In all these three cases oxygenation markedly improved with HFOV ventilation with prone positioning. Out of the three, two patients survived and one succumbed during the course of illness. We would like to hypothesize that prone positioning is feasible on HFOV and can be used as a rescue strategy for improving oxygenation and outcome when other measures fail.