IntroductionWe aimed to compare automated ventilation with closed–loop control of the fraction of inspired oxygen (FiO2) to automated ventilation with manual titrations of the FiO2 with respect to time spent in predefined pulse oximetry (SpO2) zones in pediatric critically ill patients.MethodsThis was a randomized crossover clinical trial comparing Adaptive Support Ventilation (ASV) 1.1 with use of a closed–loop FiO2 system vs. ASV 1.1 with manual FiO2 titrations. The primary endpoint was the percentage of time spent in optimal SpO2 zones. Secondary endpoints included the percentage of time spent in acceptable, suboptimal and unacceptable SpO2 zones, and the total number of FiO2 changes per patient.ResultsWe included 30 children with a median age of 21 (11–48) months; 12 (40%) children had pediatric ARDS. The percentage of time spent in optimal SpO2 zones increased with use of the closed–loop FiO2 controller vs. manual oxygen control [96.1 (93.7–98.6) vs. 78.4 (51.3–94.8); P < 0.001]. The percentage of time spent in acceptable, suboptimal and unacceptable zones decreased. Findings were similar with the use of closed-loop FiO2 controller compared to manual titration in patients with ARDS [95.9 (81.6–98.8) vs. 78 (49.5–94.8) %; P = 0.027]. The total number of closed-loop FiO2 changes per patient was 52 (11.8–67), vs. the number of manual changes 1 (0–2), (P < 0.001).ConclusionIn this randomized crossover trial in pediatric critically ill patients under invasive ventilation with ASV, use of a closed–loop control of FiO2 titration increased the percentage of time spent within in optimal SpO2 zones, and increased the total number of FiO2 changes per patient.Clinical trial registrationClinicalTrials.gov, identifier: NCT04568642.

We present a case of Horner's syndrome occurring as a complication of thyroidectomy. A 42-year-old female patient presented with eyelid drop which developed immediately after thyroidectomy for goitre. Ophthalmic examination revealed eyelid ptosis, miosis and anhidrosis. Preoperative ultrasonography showed multiple isohyperechogenic solid nodules in each lobe, consistent with multinodular goitre. Therefore, the patient underwent subtotal thyroidectomy. The ophthalmic findings did not improve at the end of 6 months follow-up. Similar cases have been reported related to neck tumours or their surgery, mediastinum-located goitre and retropharyngeal abscess surgeries, but not after benign nodular goitre surgery. Several possible mechanisms have been proposed to explain this phenomenon; anatomical variations making the patient susceptible to damage to the sympathetic chain seem to be most likely in our patient.

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We present a case of common carotid artery agenesis which is an extremely rare congenital anomaly. Less than 35 cases have been reported. These anomalies are typically asymptomatic and usually discovered as an incidental finding. Color Doppler ultrasonography is an effective and sensitive method for detecting absence of common carotid artery. But it is insufficient to identify the anomaly as a whole. Magnetic resonance angiography is a complementary technique to describe the origin of the external carotid artery and internal carotid artery.

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<b><i>Introduction:</i></b> There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. <b><i>Methods:</i></b> In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. <b><i>Results:</i></b> In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (<i>p</i> &#x3c; 0.05). The complication rate was significantly lower in the control group compared to the study group (<i>p</i> = 0.001), but the rate of revision surgeries did not differ significantly (<i>p</i> = 0.637). <b><i>Conclusion:</i></b> It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.

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