Submental intubation: A journey over the last 25 years

Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients′ and surgeons′ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access

Poly (itaconic acid) functionalized lignin/polyvinyl acetate composite resin with improved sustainability and wood adhesion strength

In this current scenario, there is a broad range of use of resins in both domestic and industrial applications. Especially the importance of resins for adhesive in the wood industry is inevitable. But most of the commercially available resins for adhesive application are prepared of formaldehyde or fossil fuel-based resources which possess serious health issues. Henceforth, development of environmentally friendly resin from renewable resources through a cost-effective technique is a challenging task. Motivated by these facts and prospects, we present a novel technique for addressing non-renewability difficulties while also improving adhesive strength of the material. In this study, lignin-based composite resin with enhanced sustainability and adhesion strength have been achieved by a simply mixing of high concentration of poly (itaconic acid)-functionalized-lignin (P(IA)-f-Lignin) and aqueous emulsion of polyvinyl acetate. The P(IA)-f-Lignin was synthesized by in-situ free radical polymerization of partly neutralized IA in the presence of aqueous lignin dispersion at 90 °C using ammonium persulfate as initiator. The formation of P(IA)-f-Lignin was confirmed by Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), nuclear magnetic resonance (NMR), field emission scanning electron microscope (FESEM) and thermogravimetric analysis (TGA). Here, we have been fabricated 20, 30, 40, 50, and 60 wt% of P(IA)-f-Lignin containing composite resin with desired amount of aqueous emulsion of polyvinyl acetate (PVAc). The changes in physico-chemical interactions were established by FTIR analysis. Various properties like viscosity, thermo-stability, and adhesive properties of all the formulated composite resin were inspected thoroughly. The composite containing 40 wt% of P(IA)-f-Lignin shows excellent improvement of adhesion strength from 3.32 ± 0.12 MPa to 7.83 ± 0.45 MPa. These fabricated composite resin with a high concentration of bio-based P(IA)-f-Lignin content and strong adhesion strength is very promising for fabrication of biobased adhesives with improved sustainability.publishedVersionPeer reviewe

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes