Impact of patient positioning on the occurrence of perioperative respiratory adverse events in children -a cluster randomised trial - The POSSUM trial.
Heather Patterson, David Sommerfield, Aine Sommerfield et al.
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In 30 seconds
The POSSUM trial was a prospective cluster-randomised trial assessing whether head elevation before and after surgery affected perioperative respiratory adverse events (PRAE) in children undergoing general anaesthesia. In Phase One, 1,935 children were allocated to a 30-degree head-elevated position (HE30) or no head elevation (NHE). Overall PRAE incidence did not differ significantly: 14% with HE30 versus 15% with NHE (p = 0.42). Among children managed with a tracheal tube, PRAE occurred less often with HE30 than NHE (18% versus 28%, p = 0.017).
Key findings
- Overall PRAE incidence was 14% with HE30 and 15% with NHE (p = 0.42).
- Among children managed with a tracheal tube, PRAE incidence was 18% with HE30 versus 28% with NHE (p = 0.017).
- For tracheal-tube patients, NHE was associated with higher PRAE odds than HE30 (OR 1.75 (95% CI 1.01-3.02 p = 0.04)).
- PRAE incidence was 14% in both Phase One and routine-practice Phase Two (OR 0.93 95%CI 0.74-1.17 p = 0.53).
Why it matters
The overall findings do not support a reduction in respiratory adverse events from routinely standardising perioperative positioning at 30 degrees for all children. The lower event incidence observed among tracheal-tube patients suggests positioning may be relevant in this subgroup, while the trial’s overall result underscores the importance of distinguishing subgroup findings from effects across the full paediatric population.
What to keep in mind
The tracheal-tube result is a subgroup finding; the abstract does not report whether this subgroup analysis was prespecified.