¿Qué pasa durante y después del síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2? / What happens during and after multisystem inflammatory syndrome in children associated with SARS-CoV-2?

Objetivo. Analizar las características clínicas y analíticas de los pacientes diagnosticados de síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2 (SIM-PedS) en la Comunidad Autónoma del Principado de Asturias, durante su ingreso y en los seis meses posteriores. Material y métodos. Estudio descriptivo, observacional, prospectivo (diciembre 2020 - junio 2022). Se incluyeron los pacientes menores de 18 años diagnosticados de SIM-PedS en la Comunidad Autónoma del Principado de Asturias. Se recogieron datos demográficos, clínicos y analíticos durante el ingreso y en los seis meses posteriores. Resultados. Durante el periodo de estudio, se incluyeron 16 pacientes (11 varones, edad mediana 10,6 años). Todos los pacientes tuvieron fiebre, 12 clínica gastrointestinal y 12 exantema. Todos los pacientes presentaron elevación de reactantes de fase aguda, 13 elevación de la porción N-terminal del pro-péptido natriurético tipo B, 10 linfopenia y 6 trombopenia. En la evaluación cardiológica durante el ingreso se encontraron alteraciones en seis pacientes. Todos los pacientes recibieron inmunoglobulinas, 14 corticoides y 6 inotrópicos. Nueve pacientes precisaron ingreso en la Unidad de Cuidados Intensivos Pediátricos (UCIP), con una estancia mediana de cuatro días. Un paciente falleció. No se han observado alteraciones reseñables ni en la clínica ni en la analítica ni en la evaluación cardiaca durante los seis meses posteriores al alta. Conclusiones. Los casos recogidos han mostrado las características clínicas y analíticas descritas en la literatura sobre el SIM-PedS, requiriendo más de la mitad ingreso en UCIP y recibiendo en todos los casos tratamiento con inmunoglobulinas. Presentaron frecuentemente afectación cardiológica, falleciendo un paciente. A los seis meses del episodio, ningún paciente ha mostrado afectación clínica, analítica ni de la función cardiaca (AU)

Aim. To analyze the clinical and analytical characteristics of patients diagnosed with Multisystem Inflammatory Syndrome in Children associated with SARS-CoV-2 (MIS-C) in the autonomous community of the Principality of Asturias, during their admission and in the subsequent six months. Material and methods. Descriptive, observational, prospective study (December 2020 - June 2022). Patients under 18 years of age diagnosed with MIS-C in the autonomous community of the Principality of Asturias were included. Demographic, clinical and analytical data were collected during admission and in the following six months. Results. During the study period, 16 patients were included (11 males, median age 10.6 years). All patients had fever, 12 had gastrointestinal symptoms and 12 had rash. All patients presented elevation of acute phase reactants, 13 elevation of the N-terminal portion of B-type natriuretic pro-peptide, 10 lymphopenia and 6 thrombopenia. In the cardiological evaluation during admission, alterations were found in six patients. All patients received immunoglobulins, 14 corticosteroids and 6 inotropes. Nine patients required admission to the Pediatric Intensive Care Unit (PICU), with a median stay of four days. One patient died. No notable alterations have been observed either in clinical symptoms, laboratory tests or cardiac evaluation during the six months after discharge. Conclusions. The cases collected have shown the clinical and analytical characteristics described in the literature on MIS-C, with more than half requiring admission to the PICU and receiving treatment with immunoglobulins in all cases. They frequently presented cardiological involvement, with one patient dying. Six months after the episode, no patient has shown clinical, analytical or cardiac function impairment (AU)

Variaciones en la incidencia de bronquiolitis tras la aparición del SARS-CoV-2 / Variations in the incidence of bronchiolitis after the onset of SARS-CoV-2

Introducción. Durante la temporada 2020-2021 se ha asistido a una disminución de la incidencia de hospitalizaciones por bronquiolitis. Los cambios en la evolución de la pandemia de SARS-CoV-2 y en la aplicación de medidas preventivas podrían relacionarse con un aumento de la incidencia de bronquiolitis grave durante la temporada 2021-2022. Objetivo. Determinar la incidencia de hospitalizaciones por bronquiolitis en un hospital terciario durante la temporada 2021-2022 y compararla con temporadas previas. Método. Estudio epidemiológico de tipo observacional, descriptivo y ambispectivo. A través de la base de datos de un hospital terciario, se compararon la incidencia, la etiología y los indicadores de gravedad de las hospitalizaciones por bronquiolitis. Se analizaron 3 cohortes en época epidémica: la temporada 2020-2021 y la 2021-2022 (prospectivas); y la temporada 2018-2019 (retrospectiva). También se analizó una cohorte prospectiva entre los meses de abril y octubre de 2021. Resultados. La incidencia acumulada de hospitalizaciones fue de 113,6/10.000 niños menores de 2 años en la temporada pre-covídica; de 3,6/10.000 en la temporada 2020-2021; y de 65,7/10.000 en la temporada 2021-2022. El porcentaje de ingresos en UCIP fue de 36,6%, 0 % y 30,8%, respectivamente. La incidencia acumulada de hospitalizaciones en el periodo no epidémico fue de 60,8/10.000, precisando ingreso en UCIP el 19%. El microorganismo más frecuente fue el virus respiratorio sincitial en todas las cohortes. Conclusiones. La incidencia durante los meses típicamente epidémicos de bronquiolitis bajó drásticamente la temporada en la que apareció el SARS-CoV-2, aumentando notablemente el año posterior, aunque sin alcanzar la incidencia previa a la pandemia. Se ha observado una incidencia alta de casos de bronquiolitis entre abril y octubre de 2021 (AU)

Introduction. A decrease has been observed during the 2020-2021 season in the incidence of hospitalizations for bronchiolitis. Changes in the evolution of the SARS-CoV-2 pandemic and in the application of preventive measures could be related to an increase in the incidence of severe bronchiolitis during the 2021-2022 season. Objective. To determine the incidence of bronchiolitis hospitalizations in a tertiary hospital during the 2021-2022 season and to compare it with previous seasons. Method. An observational, descriptive and ambispective epidemiological study. A tertiary hospital database was used to compare the incidence, etiology, and severity indicators of bronchiolitis hospitalizations. 3 cohorts were analyzed in epidemic times: the 2020-2021 season and the 2021-2022 season (prospective); and the 2018-2019 season (retrospective). A prospective cohort between the months of April and October 2021 was also analyzed. Results. The cumulative incidence of hospitalizations was 113.6/10,000 children under 2 years of age in the pre-covid season; 3.6/10,000 in the 2020-2021 season; and 65.7/10,000 in the 2021-2022 season. The percentage of admissions in PICU was 36.6%, 0% and 30.8%, respectively. The cumulative incidence of hospitalizations in the non-epidemic period was 60.8/10,000, with 19% requiring admission to the PICU. The most frequent microorganism was the respiratory syncytial virus in all cohorts. Conclusions. The incidence during the typically epidemic months of bronchiolitis drastically decreased the season in which SARS-CoV-2 appeared, noticeably increasing the next year, although without reaching the pre-pandemic incidence. A high incidence of bronchiolitis cases was observed between April and October 2021 (AU)

Tuberculosis miliar y tuberculoma coroideo en una niña de 3 meses: diagnóstico y seguimiento de un caso / Miliary tuberculosis and choroidal tuberculoma in a three-month old baby girl: Diagnosis and follow-up of a case

Se presenta a una niña de 3 meses de edad con un cuadro febril sin foco y con empeoramiento. La exploración fundoscópica mostró una lesión coroidea en el ojo izquierdo junto con lesiones en otros órganos sugestivas de tuberculosis diseminada. La evolución fue favorable tras tratamiento con cuádruple terapia antibiótica asociada a corticoterapia. La tuberculosis diseminada debe tenerse en cuenta ante un cuadro febril de tórpida evolución. La exploración oftalmológica de estos pacientes es fundamental, ya que, aunque es poco frecuente, los signos característicos de las uveítis posteriores nos orientarán hacia el diagnóstico y tratamiento precoz de esta enfermedad

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases

Miliary tuberculosis and choroidal tuberculoma in a three-month old baby girl: Diagnosis and follow-up of a case. / Tuberculosis miliar y tuberculoma coroideo en una niña de 3 meses: diagnóstico y seguimiento de un caso.

A three-month old baby girl presented with fever of unknown origin and with signs of worsening of this episode. Funduscopy showed a solitary choroidal lesion in her left eye, as well as extraocular lesions suggesting disseminated tuberculosis. A favourable outcome was achieved after quadruple antibiotic course and cortisone therapy. Disseminated tuberculosis should be considered in cases of fever of unknown origin in children with an unsatisfactory evolution. Ocular examination is mandatory, due to the possible posterior uveitis signs that can help with early diagnosis and treatment of some diseases.

Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask / Seguridad de la aerosolterapia durante la ventilación mecánica no invasiva con helmet y mascarilla facial total en población pediátrica

Purpose: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. Design: A descriptive analytical study of a prospective patient cohort was carried out. Ambit: Pediatric intensive care unit (PICU) of a tertiary hospital. Patients: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. Interventions: Nebulized treatment was added according to medical criteria. Variables of interest: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. Results: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). Conclusions: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients

Objetivo: Evaluar las consecuencias de la medicación nebulizada en pacientes con ventilación no invasiva (VNI) con mascarilla facial total (MFT) y casco. Diseño: Estudio analítico descriptivo sobre una cohorte prospectiva de pacientes. Ámbito: UCIP de hospital de tercer nivel. Pacientes: Todos los pacientes ingresados en UCIP (muestreo consecutivo) con VNI con casco o MFT durante 29 meses. No se excluyeron pacientes. Intervenciones: Se añadió tratamiento nebulizado según criterio médico. Variables de interés: Independientes: edad, sexo, diagnóstico, gravedad, parámetros ventilatorios y medicación nebulizada (si se utilizaba). Secundarias: duración, fallo de VNI y estancia en UCIP. Resultados: Los diagnósticos más frecuentes fueron bronquiolitis (60,5%) y asma (23%). La mediana de conexión a VNI fue de 43 horas. Se administraron nebulizaciones durante la VNI en un 40% sin registrarse efectos adversos. La probabilidad calculada de tener un efecto adverso fue 1,3% con casco y 0,5% con MFT (estadística bayesiana, intervalo de probabilidad 95%). Los pacientes con casco y aerosolterapia tenían mayor gravedad que los que no recibieron nebulizaciones, sin encontrarse diferencias en la necesidad de cambiar a modalidad con doble nivel de presión. En los pacientes con MFT la estancia en UCIP fue menor (p=0,033) a pesar de no existir diferencias en el nivel de gravedad; la tasa de fallo de VNI fue mayor en los que no recibieron nebulizaciones (p=0,024). Conclusiones: La probabilidad de tener un efecto adverso relacionado con la nebulización es baja utilizando casco o MFT. La terapia inhalada con MFT puede disminuir la estancia en UCIP en algunos pacientes

Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask.

PURPOSE: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. DESIGN: A descriptive analytical study of a prospective patient cohort was carried out. AMBIT: Pediatric intensive care unit (PICU) of a tertiary hospital. PATIENTS: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. INTERVENTIONS: Nebulized treatment was added according to medical criteria. VARIABLES OF INTEREST: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. RESULTS: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). CONCLUSIONS: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.

High-flow nasal cannula oxygenation for everyone? Not so fast / ¿Oxigenación con cánula nasal de alto flujo para todos? No tan rápido

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Ventilación no invasiva / Non-invasive ventilation

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Ossiculum terminale de Bergman. Una entidad poco conocida / Ossiculum terminale Bergmann. A poorly known entity

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Tumor hinchado de Pott complicado con empiemas epidurales / Pott's puffy tumour complicated with epidural empyemas

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Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo / Thrombosis and obstruction associated with central venous lines. Incidence and risk factors

Objetivo: Analizar la incidencia de trombosis y obstrucción asociada a las vías centrales implantadas a niños críticamente enfermos y la determinación de sus factores de riesgo. Diseño: Estudio prospectivo observacional, desarrollado en una unidad de cuidados intensivos pediátrica de un hospital universitario. Material y método: Se analizaron 825 catéteres venosos centrales (CVC) insertados en 546 pacientes. Se recogieron la edad, el sexo, el peso, el tipo de catéter (luces, tamaño, marca), la localización final del catéter, la existencia de ventilación mecánica, el tipo de sedación y analgesia utilizado, el médico que realizó la técnica, el fallo inicial del residente con posterior canalización por el adjunto, el número de intentos, la indicación, la enfermedad de base, el diagnóstico de ingreso, el tipo de cateterización (urgente, programada o recanalización) y las complicaciones mecánicas tardías (CMT). Se determinaron los factores de riesgo para estas complicaciones mediante un análisis de regresión múltiple. Resultados: Se registraron 52 CMT (6,14%), 42 obstrucciones y 10 trombosis. Las tasas de obstrucción y trombosis fueron de 4,96 y 1,18 por cada 100 CVC, respectivamente. El único factor de riesgo asociado de forma independiente a la obstrucción fue el tiempo de duración del CVC (OR = 1,05, IC del 95%, 1,00-1,10). Respecto a la trombosis, tanto el número de luces (OR = 4,88, IC del 95%, 1,26-18,90) como la nutrición parenteral (OR = 4,17, IC del 95%, 1,06-16,31) alcanzaron significación estadística en el análisis bivariante. Sin embargo, no se objetivaron factores de riesgo para trombosis en el análisis multivariante. Conclusiones: La obstrucción y la trombosis de los CVC insertados en una unidad de cuidados intensivos pediátrica de un hospital universitario son relativamente frecuentes. El tiempo de duración de la vía central es un factor de riesgo independiente para la obstrucción de alguna de sus luces (AU)

Objective: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. Design: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. Material and method: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. Results: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. Conclusions: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction (AU)

[Thrombosis and obstruction associated with central venous lines. Incidence and risk factors]. / Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo.

OBJECTIVE: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. DESIGN: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. MATERIAL AND METHOD: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. RESULTS: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. CONCLUSIONS: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction.

Neurotoxicidad subaguda letal por metotrexato intratecal / Intrathecal methotrexate induced lethal subacute neurotoxicity

El metotrexato es un inhibidor de la dihidrofolato reductasa ampliamente utilizado en el tratamiento de la leucemia, el linfoma y otros tumores sólidos en pacientes pediátricos. Se ha descrito que puede producir neurotoxicidad por mecanismos aún no bien aclarados. La toxicidad neurológica puede ser aguda, subaguda o crónica, según el tiempo de manifestación tras la administración del fármaco. La clínica suele ser reversible, pero ocasionalmente causa la muerte del paciente o importantes secuelas, por lo que conviene vigilar a los pacientes en riesgo. La resonancia magnética nuclear es útil en el diagnóstico, mostrando alteraciones en la difusión de manera precoz. Se han ensayado tratamientos farmacológicos pero ninguno ha demostrado su eficacia actualmente. Presentamos el caso de un adolescente de 15 años de edad con leucemia linfoblástica aguda tipo B que se encontraba en remisión completa y sin infiltración del sistema nervioso central tras la terapia de inducción y consolidación. Después de la administración de metotrexato intratecal desarrolla neurotoxicidad subaguda grave, con deterioro neurológico progresivo hasta un estado de coma persistente con graves alteraciones en la resonancia magnética y el trazado electroencefalográfico. La clínica no mejora con ningún tratamiento. El paciente falleció tras realizarse limitación del esfuerzo terapéutico de acuerdo con la familia (AU)

Methotrexate inhibits dihydrofolate reductase and it is widely used in the treatment of leukemia, lymphoma and other tumors in paediatric patients. There has been described that can produce neurotoxicity for still not well clarified mechanisms. Neurological toxicity can be acute, subacute or chronic, according to the time of manifestation after the administration of the drug. Neurological symptoms often are reversible, but occasionally methotrexate can produce the death of the patient or cause important sequels. For this reason is important to monitor patients in risk. Magnetic resonance imaging is very useful in diagnosis, showing alterations in diffusion-weighted imaging of a precocious way. Several pharmacological treatments have been proved but none of them have demonstrated its efficiency until now. We present the case of a 15-year-old boy diagnosed of acuteB-cell lymphoblastic leukemia in complete remission and without central nervous system leukemic involment postinduction and consolidation therapy. After the administration of intrathecal methotrexate he develops severe subacute neurotoxicity. Neurological symptoms were deteriorating progressively up to a persistent coma with serious alterations in magnetic resonance imaging and electroencephalogram pattern. Clinic did not improve with any treatment. The patient died after limitation of therapeutic effort of agreement by the family (AU)

Montaje y manejo del sistema helmet-CPAP en lactantes y niños con insuficiencia respiratoria aguda / Assembly and management of helmet-CPAP in infants and children with acute respiratory insufficiency

La aplicación de presión positiva continua (CPAP) en la insuficiencia respiratoria aguda a través de una interfase tipo helmet es un método poco conocido en pediatría. El objetivo de este trabajo es describir los elementos necesarios para su montaje, el procedimiento de su colocación y los cuidados necesarios por parte del personal de enfermería. Además, se indican las ventajas y desventajas del helmet con respecto a otras interfases (AU)

Application of continuous positive airway pressure (CPAP) during respiratory insufficiency through a helmet interface is not well known in the Pediatric practice. The objective of this paper is to describe the necessary elements for it assembly, management and nursing care. The advantages and disadvantages of helmet compared to other interfaces are also discussed (AU)

Predicción del índice PaO2/FiO2 a partir del índice SpO2/FiO2 ajustado por la medición transcutánea de CO2 en niños críticamente enfermos / Prediction of PaO2/FiO2 ratio from SpO2/FiO2 ratio adjusted by transcutaneous CO2 measurement in critically ill children

Objetivo: Evaluar si la inclusión de la medición transcutánea de CO2 (PtcCO2) mejora el modelo de predicción del índice presión arterial de oxígeno/ fracción inspirada de oxígeno [PaO2/FiO2 (P/F)] a partir del índice saturación de oxígeno/FiO2 [SpO2/FiO2 (S/F)]. Métodos: Análisis retrospectivo de datos gasométricos correspondientes a niños críticamente enfermos. Se incluyen PaO2, SpO2, FiO2 y PtcCO2 de 40 muestras en 8 pacientes. Se calculó un modelo de regresión lineal múltiple para predecir el índice P/F a partir del índice S/F y la PtcCO2. Con la fórmula obtenida se obtuvieron los valores de índice S/F correspondientes con los valores de índice P/F de 200 y 300 para distintos niveles de PtcCO2. Se determinaron las curvas de características operador receptor para los valores corte del índice P/F (200 y 300). Resultados: El modelo de regresión lineal fue: P/F=37,277+(1,072×S/F) – (1,567×PtcCO2); p<0,0001; R2=0,469. Con esta ecuación, para una PtcCO2 de 40 mmHg, valores de índice P/F de 200 y 300 correspondieron respectivamente a valores de índice S/F de 295,1 y 426,5. Un índice P/F calculado menor de 256,7 equivaldría a un índice P/F real menor de 200 (sensibilidad 84,6%; especificidad 85,2%) y un índice P/F calculado menor de 297,6 equivaldría a un índice P/F real menor de 300 (sensibilidad 89,7%; especificidad 82%). Conclusión: La PtcCO2 modifica la predicción del índice P/F a partir del índice S/F. Son necesarios estudios prospectivos que validen en una muestra más amplia los resultados encontrados en este estudio (AU)

Objective: To evaluate if the inclusion of the transcutaneous CO2 tension measurement (PtcCO2) can improve partial pressure of oxygen/ fraction of inspired oxygen ratio [PaO2/FiO2 (P/F)] prediction from pulse oximetry saturation/FiO2 ratio [SpO2/FiO2 (S/F)]. Methods: Retrospective analysis of blood gas data from critically ill children. PaO2, SpO2, FiO2 and PtcCO2 from 40 samples in 8 patients were analysed. A multiple linear regression model was performed to predict P/F ratio from S/F ratio and PtcCO2. Using the equation obtained, S/F ratio values were calculated for P/F ratios of 200 and 300 and different levels of PtcCO2. Receiver Operator Characteristic (ROC) curves were made to analyse the diagnostic values of P/F ratio (200 and 300). Results: The linear regression model was: P/F=37.277+(1.072×S/F) – (1.567×PtcCO2); P<0.0001; R2=0.469. Using the equation, for a PtcCO2 value of 40 mmHg, P/F ratios of 200 and 300 corresponded to S/F ratios of 295.1 and 426.5, respectively. Computed P/F ratio less than 256.7 had 84.6% sensitivity and 85.2% specificity for the diagnosis of P/F ratio less than 200. Computed P/F ratio less than 297.6 had 89.7% sensitivity and 82% specificity for the diagnosis of P/F ratio less than 300. Conclusion: PtcCO2 has a significant influence on the prediction of P/F ratio from S/F ratio. Prospective studies with more patients are needed to validate these results (AU)