Awake proning of a 2‐year‐old extubated child with severe COVID‐19 pneumonitis

Alseoudy, M. M.; Abo Elfetoh, M. A.; Alrefaey, A. K.

With the progress of the coronavirus disease 2019 (COVID‐19) pandemic, available data suggest lower complications and disease severity in children and young patients. Despite most paediatric cases being mild in severity, some children require intensive care and mechanical ventilation due to the development of paediatric severe acute respiratory distress. The use of adjuvant therapies in severely ill paediatric patients has not been reported widely in the literature. Prone positioning in spontaneously breathing children has, to our knowledge, not yet been described. In our report, the trachea of a 2‐year‐old child was intubated, and he was mechanically ventilated for severe bilateral pneumonia. The infant and his mother tested positive for severe acute respiratory syndrome coronavirus disease‐2 (SARS‐CoV‐2) infection with reverse transcription‐polymerase chain reaction testing from nasopharyngeal swabs. Immediately after tracheal extubation, the child developed severe respiratory distress and refractory hypoxia. Awake prone position was employed as a rescue therapy for the management of post‐extubation hypoxia, resulting in a dramatic improvement in oxygenation. Prone positioning in the paediatric patient may improve oxygenation and can be a useful adjuvant for respiratory therapy either before, during or after invasive mechanical ventilation. Awake prone position may be considered as an option for the management of COVID‐19 in paediatric patients, but it requires patient cooperation.