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BACKGROUND: Intranasal dexmedetomidine associated with midazolam has been used for pediatric magnetic resonance imaging studies because immobility is a fundamental requirement for correct execution. Many studies have shown dexmedetomidine to be a good option for non-operating room sedation. However, identifying the optimal dose remains a key challenge, especially for pediatric patients. METHODS: All medical records of 139 pediatric patients who underwent sedation for magnetic resonance imaging studies between September 2021 and November 2022 at the University Hospital of Salerno, Italy, were retrospectively reviewed about success rate and adverse events. Our protocol required dosing 30 minutes before the procedure. Patients weighing up to 40 kg received intranasal dexmedetomidine (3 µg/kg) with intranasal midazolam (0.2 mg/kg). Those weighing more than 40 kg received intranasal dexmedetomidine (2 µg/kg) with midazolam orally (0.3 mg/kg; maximum dose, 15 mg). RESULTS: A total of 139 pediatric patients, with age range between 2 months and 16 years, median (95% confidence interval) of 3 (3-5) years, and weight range between 4 and 70 kg, median (95% confidence interval) of 19 (15-24) kg, were reviewed.The procedure was satisfactorily completed in 93.5% (130 patients) (P < 0.01). Only 9 (6.5%) patients completed the procedure with general anesthesia; there are hot adverse events. CONCLUSIONS: Our experience with association of intranasal dexmedetomidine and midazolam has a high success rate, with high effectiveness and safety.

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Spinal cord injury (SCI) is a severe lesion comporting various motor, sensory and sphincter dysfunctions, abnormal muscle tone and pathological reflex, resulting in a severe and permanent lifetime disability. The primary injury is the immediate effect of trauma and includes compression, contusion, and shear injury to the spinal cord. A secondary and progressive injury usually follows, beginning within minutes and evolving over several hours after the first ones. Because ischemia is one of the most important mechanisms involved in secondary injury, a treatment to increase the oxygen tension of the injured site, such as hyperbaric oxygen therapy, should theoretically help recovery. Although a meta-analysis concluded that hyperbaric oxygen therapy might be helpful for clinical treatment as a safe, promising and effective choice to limit secondary injury when appropriately started, useful and well-defined protocols/guidelines still need to be created, and its application is influenced by local/national practice. The topic is not a secondary issue because a well-designed randomized controlled trial requires a proper sample size to demonstrate the clinical efficacy of a treatment, and the absence of a common practice guideline represents a limit for results generalization. This narrative review aims to reassemble the evidence on hyperbaric oxygen therapy to treat SCI, focusing on adopted protocols in the studies and underlining the critical issues. Furthermore, we tried to elaborate on a protocol with a flowchart for an evidence-based hyperbaric oxygen therapy treatment. In conclusion, a rationale and shared protocol to standardize as much as possible is needed for the population to be studied, the treatment to be adopted, and the outcomes to be evaluated. Further studies, above all, well-designed randomized controlled trials, are needed to clarify the role of hyperbaric oxygen therapy as a strategic tool to prevent/reduce secondary injury in SCI and evaluate its effectiveness based on an evidence-based treatment protocol. We hope that adopting the proposed protocol can reduce the risk of bias and drive future studies.

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Pulse oximetry is now a widely available technology that provides easy and continuous reliable measurements of oxygen saturation, the percentage of O2 bound to Hb (SpO2). Pulse oximetry has become a standard monitoring not only in intensive care, but also in other clinical settings, although several factors can interfere with a correct reading, as low perfusion conditions, such as low cardiac output, vasoconstriction, hypothermia. We performed a prospective observational study in two groups of twenty-eight patients admitted to the ICU, in which we compared the values ​​obtained (SpO2) with digital and forehead pulse oximetry, with arterial oxygen saturation (SaO2) obtained from blood gas analysis (EGA). Comparison measurements into two distinct groups, though homogeneous might be a limitation of the study, but at the same time provide a representative picture of a polyvalent intensive care unit. The result was that both the values ​​obtained with digital and frontal pulse oximetry are accurate and reliable in comparison to EGA. In situations of hypoxia, the reliability of frontal pulse oximetry appears superior compared to digital oximetry.

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Hypertension is responsible for a significantly increased burden of cardiovascular events and it is cause and a consequence of Chronic Kidney Disease (CKD) and a determinant factor in its progression to End Stage Kidney Disease (ESKD). Therefore, nephrologists have been focusing their attention on hypertension control to prevent CKD progression, delaying it but with poor results on cardiovascular mortality reduction. An important effect is the difficulty to adequately reduce BP levels in CKD patients and especially in dialysis patients despite the polipharmacological therapy. We have to take into account other aspects influencing mortality risk in CKD patients .The first aspect to consider is whether brachial blood pressure (BP) measurement is sufficient to describe the complex relationship between the alteration of BP and outcomes in renal subjects. The second aspect to consider is the variability of BP (BPV). We think that BP measurement cannot only take into account brachial BP, because it represents a limited measure of a complex clinical condition in CKD or ESRD patients. The inability to evaluate hypertension in its complexity explains why several aspects are still unrecognized.

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This case report has the scope to review the etiology and pathophysiology of pneumomediastinum in severe blunt trauma, with a special interest to its more frequent origin: the Macklin effect. The Macklin effect is a pathophysiologic process characterized by the blunt traumatic alveolar ruptures, air dissection along bronchovascular sheaths, with the formation of blunt pulmonary interstitial emphysema, radiologic marker, until the formation of a pneumomediastinum. Its premature diagnostic acknowledgment is important in the managing of the blunt chest trauma.

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