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Prone positioning and high-frequency oscillatory ventilation in early paediatric acute respiratory distress syndrome (PROSpect): an international, two-by-two factorial, response-adaptive, phase 3, randomised controlled trial.

Lancet (London, England)·October 31, 2026·PMID 42956771

Why it matters

Prone positioning and HFOV are widely used in paediatric ARDS despite inconclusive evidence. This trial provides high-quality data that neither improves ventilator-free days and both carry specific harms, supporting a recommendation against routine first-line use.

Infographic summary of Prone positioning and high-frequency oscillatory ventilation in early paediatric acute respiratory distress syndrome (PROSpect): an international, two-by-two factorial, response-adaptive, phase 3, randomised controlled trial.
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MedLit · Evidence, Distilled