In vitro testing of cyanoacrylate tissue adhesives and sutures for extracorporeal membrane oxygenation cannula securement

The occurrence of pressure injuries and related risk factors in patients undergoing extracorporeal membrane oxygenation for respiratory failure: A retrospective single centre study

INTRODUCTION

Limited data is available regarding the incidence of pressure injuries in patients who have undergone Extracorporeal Membrane Oxygenation (ECMO), a life-saving technique that provides respiratory support for hypoxemia that does not respond to conventional treatment.

AIM

To assess the incidence of pressure injuries and identify the risk factors in Acute Respiratory Distress Syndrome patients receiving ECMO.

METHODS

A retrospective observational study utilizing prospectively collected data was performed in an Italian intensive care unit, between 1 January 2012 and 30 April 2022 enrolling all consecutive patients with Acute Respiratory Distress Syndrome who underwent ECMO.

RESULTS

One hundred patients were included in this study. 67 patients (67%) developed pressure injuries during their intensive care unit stay, with a median of 2 (1-3) sites affected. The subgroup of patients with pressure injuries was more hypoxic before ECMO implementation, received more frequent continuous renal replacement therapy and prone positioning, and showed prolonged ECMO duration, intensive care unit and hospital length of stay compared to patients without pressure injuries. The logistic model demonstrated an independent association between the pO2/FiO2 ratio prior to ECMO initiation, the utilization of the prone positioning during ECMO, and the occurrence of pressure injuries.

CONCLUSIONS

The incidence of pressure injuries was elevated in patients with Adult Respiratory Distress Syndrome who received ECMO. The development of pressure injuries was found to be independently associated with hypoxemia before ECMO initiation and the utilization of prone positioning during ECMO.

IMPLICATIONS FOR CLINICAL PRACTICE

Patients who require ECMO for respiratory failure are at a high risk of developing pressure injuries. To ensure optimal outcomes during ECMO implementation and treatment, it is vital to implement preventive measures and to closely monitor skin health in at-risk areas.

Ten years of clinical experience with cyanoacrylate glue for venous access in a 1300-bed university hospital

In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade.

Facile Preparation of Tunicate-Inspired Chitosan Hydrogel Adhesive with Self-Healing and Antibacterial Properties

In order to replace traditional wound treatments such as sutures, tissue adhesives with strong wet tissue adhesion and biocompatibility have attracted more attention to the applications of non-invasive wound closure. Herein, inspired by tunicate adhesive protein, a series of 2,3,4-trihydroxybenzaldehyde (TBA)-modified chitosan hydrogels (CS-TBA-Fe) were prepared by easily mixing the solutions of chitosan-FeCl₃ and TBA via the Schiff-base reaction and the coordination between Fe³⁺ and pyrogallol groups. The gelation time was greatly shortened to only several seconds after induced even trace Fe³⁺. The hydrogel (CS-TBA-Fe) exhibited ~12-fold enhanced wet tissue adhesion strength (60.3 kPa) over the commercial fibrin glue. Meanwhile, the hydrogel also showed robust adhesion to various substrates such as wood, PMMA, and aluminum. The swelling ratio and rheological property can be simply controlled by changing the concentrations of chitosan, TBA, and Fe³⁺. Moreover, the hydrogel displayed a rapid and highly efficient self-healing ability and an excellent antibacterial activity against E. coli. The overall results show that the CS-TBA-Fe hydrogel with enhanced wet adhesiveness will be a promising tissue adhesive material.