SpO2/FiO2 as a predictor of non-invasive ventilation failure in children with hypoxemic respiratory insufficiency.

Generally, monitoring of hypoxemia has been always based on partial pressure of arterial oxygen to fraction of inspired oxygen ratio; recently it was confirmed a good correlation between this ratio and a non-invasive alternative ratio of oxygen saturation to fraction of inspired oxygen (SF ratio = SpO2/FiO2). The SF ratio has been studied and validated, especially in the intubated patients, however studies monitoring patients treated with non-invasive ventilation (NIV) are lacking. The aim of the study was to determine if the SF ratio is a reliable predictive factor for failure of NIV in pediatric patients diagnosed with hypoxemic acute respiratory failure due to pneumonia. A five year retrospective study with consecutive sampling of patients diagnosed with hypoxemic acute respiratory failure due to pneumonia, admitted to the pediatric intensive care unit in a university hospital and treated with NIV was conducted. Physiological and ventilator variables were collected before starting NIV and at 2, 8 and 12 hours of treatment, and the corresponding SF ratios calculated. Thirty-four patients were studied. NIV failed in seven patients. Significant differences in SF ratio were observed between the successful and unsuccessful patients at the onset, 2 and 12 hours of treatment. Multivariable analysis revealed the SF ratio at two hours to be an independent predictor of NIV failure (odds ratio = 0.96, 95% confidence intervals 0.93-0.99; P = 0.015). Area Under Receiver Operating Characteristic curve = 0.90 (95% confidence interval = 0.79 to 1.000), optimal cut off value for SF at 2 hours ≤ 189; sensitivity = 86%, specificity = 74%. In conclusion, the SF ratio of 189 or less at 2 hours of NIV seems to be useful for predicting NIV failure in this cohort.

Association of atlanto-occipital dislocation and retroclival haematoma in a child.

INTRODUCTION: The authors present the case of a 5-year-old girl with traumatic hydrocephalus secondary to a retroclival haematoma associated with atlanto-occipital dislocation (AOD) after a motor vehicle accident. Clinical history and neuroimaging of the patient are described. DISCUSSION: Computed tomography (CT) imaging of the head revealed a retroclival haematoma with secondary hydrocephalus. The cranio-cervical junction showed an AOD that was initially overlooked. Traumatic AOD is a rare diagnosis although in the recent years it has become an emergent entity due to the improvement of emergency medical treatment on the field. CONCLUSION: An initial diligent imaging study and interpretation should be made to avoid misdiagnosis and to provide adequate treatment. This is the first case reported of the association of AOD, hydrocephalus and retroclival haematoma. A brief review of the literature is also presented.

Highly enantioselective synthesis of fluorinated gamma-amino alcohols through proline-catalyzed cross-Mannich reaction.

A new, simple route for the synthesis of fluorinated beta-alkyl gamma-amino alcohols in optically pure form in only two steps and featuring proline catalysis from inexpensive and readily available starting materials is described. The applied strategy allows for the introduction of diversity into both the beta-fluoroalkyl and alpha-alkyl groups of these compounds. [reaction: see text]