OBJECTIVE The Airway Section of the Spanish Society of Anaesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), the Latin American Federation of Emergency Medicine (FLAME) and an international group of airway experts (IAG) aimed to establish multidisciplinary recommendations advocating for the universal use of videolaryngoscopy (VL) in both emergency and planned care settings. DESIGN A committee of experts from the two national scientific societies and an international group of airway experts was convened. Relevant research questions aligning with the document's objective were identified. A rapid systematic review of the evidence was performed, and the quality of evidence was assessed. Recommendations were formulated using the GRADE methodology (Grading of Recommendations Assessment, Development, and Evaluation) The entire process was conducted independently of industry funding. METHODS Six domains were defined pertaining to VL: Clinical Benefits; Infrastructure and Accessibility; Clinical Guidelines and Protocols; Teaching and Clinical Training; Dissemination and Promotion of Clinical Benefits; Innovation, Sustainability, and Research. For each domain, specific questions were developed using the PICO model (Population, Intervention, Comparison, and Outcomes). A literature search was conducted following PRISMA-R guidelines and analysed using the GRADE methodology. RESULTS The synthesis process resulted in 12 recommendations. Due to the low quality of available evidence, most recommendations were formulated based on expert opinion. CONCLUSION The experts achieved strong consensus, formulating 12 recommendations to support strategies aimed at universalising the use of videolaryngoscopy. Export

Clavulanic acid (CA) is an irreversible β-lactamase enzyme inhibitor with a weak antibacterial activity produced by Streptomyces clavuligerus (S. clavuligerus). CA is typically co-formulated with broad-spectrum β‑lactam antibiotics such as amoxicillin, conferring them high potential to treat diseases caused by bacteria that possess β‑lactam resistance. The clinical importance of CA and the complexity of the production process motivate improvements from an interdisciplinary standpoint by integrating metabolic engineering strategies and knowledge on metabolic and regulatory events through systems biology and multi-omics approaches. In the large-scale bioprocessing, optimization of culture conditions, bioreactor design, agitation regime, as well as advances in CA separation and purification are required to improve the cost structure associated to CA production. This review presents the recent insights in CA production by S. clavuligerus, emphasizing on systems biology approaches, strain engineering, and downstream processing.

This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV). NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation. Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done. Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile. Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations. Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938–948.