Early pneumonia and timing of antibiotic therapy in patients after nontraumatic out-of-hospital cardiac arrest

BACKGROUND: While early pneumonia is common in patients after out-of-hospital cardiac arrest (OHCA), little is known about the impact of pneumonia and the optimal timing of antibiotic therapy after OHCA. METHODS: We conducted a 5-year retrospective cohort study, including patients who suffered from OHCA and were treated with therapeutic hypothermia. ICU treatment was strictly standardized with defined treatment goals and procedures. Medical records, chest radiographic images and microbiological findings were reviewed. RESULTS: Within the study period, 442 patients were admitted to our medical ICU after successfully resuscitated cardiac arrest. Of those, 174 patients fulfilled all inclusion and no exclusion criteria and were included into final analysis. Pneumonia within the first week could be confirmed in 39 patients (22.4 %) and was confirmed or probable in 100 patients (57.5 %), without a difference between survivors and non-survivors (37.8 % vs. 23.1 % confirmed pneumonia, p = 0.125). In patients with confirmed pneumonia a tracheotomy was performed more frequently (28.2 vs. 12.6 %, p = 0.026) compared to patients without confirmed pneumonia. Importantly, patients with confirmed pneumonia had a longer ICU- (14.0 [8.5-20.0] vs. 8.0 [5.0-14.0] days, p < 0.001) and hospital stay (23.0 [11.5-29.0] vs. 15.0 [6.5-25.0] days, p = 0.016). A positive end expiratory pressure (PEEP) > =10.5 mbar on day 1 of the hospital stay was identified as early predictor of confirmed pneumonia (odds ratio 2.898, p = 0.006). No other reliable predictor could be identified. Median time to antibiotic therapy was 8.7 [5.4-22.8] hours, without a difference between patients with or without confirmed pneumonia (p = 0.381) and without a difference between survivors and non-survivors (p = 0.264). Patients receiving antibiotics within 12 hours after admission had a shorter ICU- (8.0 [4.0-14.0] vs. 10.5 [6.0-16.0] vs. 13.5 [8.0-20.0] days, p = 0.004) and hospital-stay (14.0 [6.0-25.0] vs. 16.5 [11.0-27.0] vs. 21.0 [17.0-28.0] days, p = 0.007) compared to patients receiving antibiotics after 12 to 36 or more than 36 hours, respectively. CONCLUSIONS: Early pneumonia may extend length of ICU- and hospital-stay after OHCA and its occurrence is difficult to predict. A delayed initiation of antibiotic therapy in OHCA patients may increase the duration of the ICU- and hospital-stay. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1191-y) contains supplementary material, which is available to authorized users

Active Commuting Luggage

Bike commuting is a great way for people to get more out of their day. The extra exercise and outdoor time is often a welcome stress relief from hectic work days. Since US work culture rarely provides accommodation for employees who actively commute, rider’s equipment choices are crucial to fitting into the office after they arrive. The existing market for bike commuting backpacks focuses on the ride, and fail to address what comes after. Current bags are designed with large spaces that do not separate things needed for the workday, and sweaty items from the commute. My pack addresses this by discreetly isolating internal sections, allowing the bag to be used professionally during the workday. This project was conducted as an Industrial Design thesis, and the results were found through user surveys, observations, market research, and iterations of sketching and prototyping

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About 12 students are gathered in a small room in the old Landscape Architecture building. One of the students steps up to make a presentation on his intended major and resulting opportunities. Others take notes and make comments about the presenter on a rubric sheet. This might seem like any other English class one is required to take before graduation. However, these students haven’t yet started with for-credit classes

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Ethos talks to Katey Way, dressed as Princess Mononoke from the movie Princess Mononoke, about the incredibly popular culture that is cosplay; from becoming and portraying genuine characters to congregating together to collectively form a great appreciation and passion for the art

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