Résumé
Changes in body position can significantly improve gas exchange with few complications related to the maneuver. This may result in a shorter stay in the critical care unit and improved outcome for the critically ill patient. This study was carried out on 60 neonates [39 females, 21 males] admitted to the neonatal intensive care unite, Tanta University Hospital. All neonates were suffering from respiratory failure and requiring intubation and mechanical ventilation. Patients were classified into four groups group la includes 15 neonates who were ventilated by PCV mode in the prone position. Group IIb includes 15 neonates who were ventilated by PCV mode in the supine position. Group Ila includes 15 neonates who were ventilated by SIMV mode in the prone position. Group lib includes 15 neonates who were ventilated by SIMV mode in the supine position. In group la and Ila, parameters were measured during supine position before turning infants to the prone position [baseline] and then they were turned prone and parameters were measured after 1 hour. Infants remained in the prone position for 20 hours and parameters were measured again and after those infants returned to the supine position and parameters were measured after 1 hour. In group Ib and lIb, parameters were measured at baseline after 1 hour, 20 hours and 21 hours. The results of our study showed that there was a significant increase in tidal volume in group Ila when compared to group lIb at 1 hour and 20 hours after turning infants to the prone position but there was no significant difference after returning to the supine position. Also there was a significant decrease in mean airway pressure in group la and Ila when compared to group Ib and lib respectively after 20 hours of the prone position and also after returning to the supine position. The results of our study also showed a significant improvement in PaO[2]k/FiO[2] ratio and SpO[2] after turning infants to the prone position and also after returning to the supine position when compared to the base line data. When comparing short duration of prone position to long duration there were also a significant improvement in PaO[2]/FiO[2] and SpO[2] with longer duration of the prone position. When comparing group la and Ila to Ib and lIb respectively, PaO[2]/FiO[2] ratio and SpO[2] were significantly higher in group la and Ila. When comparing group la to Ila, PaO[2]/FiO[2] ratio and SpO[2] were significantly higher in group Ila. Our results revealed that the oxygenation index was significantly lower [better oxygenation] after turning infants to the prone position and also after returning to the supine position when compared to the base line data. When comparing short duration of prone position to long duration there were also a significant decrease in oxygenation index with longer duration of the prone position. When comparing group la and Ila to Ib and lIb respectively, the oxygenation index was significantly lower in group la and Ila. When comparing group la to Ila, the oxygenation index was significantly lower in group Ila. But there were no significant changes in PH, PaCO[2], HCO[3], minute volume, heart rate and mean arterial blood pressure either within the same group or when comparing the groups with each other. Prone positioning can be accomplished safely and it should be done early in critically ill neonates with respiratory failure. Prone positioning for long periods [20 hours/day] have a cumulative and persistent improvement in oxygenation with less airway pressure even after return to the supine position