Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE®, EMBASE™, CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), −12 mmHg; 95% confidence interval (CI), −17 to −8] and heart rate (MD, −8 beats·min−1; 95% CI, −11 to −5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Gain and transient photoresponse of quantum well infrared photodetectors: A detailed ensemble Monte Carlo study

We investigate different gain characteristics observed on quantum well infrared photodetectors (QWIPs) fabricated with various material systems, and the effects of barrier material properties on the device characteristics through detailed ensemble Monte Carlo simulations. When the energy spacing between the central and satellite valleys is increased, the improvement in the excited electron lifetime is found to be much stronger than that in the average electron velocity in the device. According to our results, relatively high gain observed in InP/In0.53Ga0.47As QWIPs under large bias is not due to the higher mobility in InP as suggested earlier; it can mainly be attributed to higher excited electron lifetime as a result of relatively large Γ–L energy spacing. We discuss the details of the fast part of the Al0.3Ga0.7As/GaAs QWIP transient photoresponse, which exhibits three regions with different decay characteristics under a short pulse of radiation. The duration of the final region, during which the electrons excited near the emitter are extracted from the collector, is observed to be considerably long due to the dispersion of the photoelectrons. The photoresponse time rapidly decreases with increasing bias under low bias, and nearly saturates at ∼10 ps under large bias being ∼40% larger than the average transit time estimated by dividing the device length to the average steady-state electron velocity in device. We also investigate the effects of the interface reflections on the photoresponse time

Dentists’ knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders

Aims: The aim of this study was to investigate dentist’s approaches to the use of splint therapy for myofascial pain, bruxism, and temporomandibular joint (TMJ) disorders and to assessment of treatment modalities.Materials and Methods: A 12‑item questionnaire was developed to determine dentists’ knowledge of TMJ disorders and approaches for occlusal splint treatments. The researchers spoke with each dentist included in the study at his/ her clinic or by telephone to assess their immediate knowledge and approach to the TMJ disorders. Chi‑squared test was performed to analyze the values. The confidence interval was set as 95%.Results: A total of 370 dentists working in Turkey were participated in this study. The most common splint application reason for occlusal splint treatment was bruxism (77.8%) while TMJ pain was very rare (%1.4). The use of hard splint ratios for 0–5 years of professional experience was 57.0%, 42.4.0%, and 26.8% for the experience of 5–15 years and over 15 years groups, respectively (P < 0.001). While the dentists’ with sufficient knowledge soft splint application rates were 11.6%, hard splint application rates were 43.4% for the dentists with sufficient knowledge. Occlusion adjustment rate of dentists who practice in all three groups was under 16.0%.Conclusions: The knowledge of the dentists about TMJ disorders and occlusal splint therapy were found to be insufficient. Their knowledge decreased with increasing experience.Keywords: Bruxism, occlusal splints, surveys, temporomandibular joint disorder