This retrospective multicenter study compared microorganisms documented by quantitative cultures from bronchoscopic samples in episodes of ventilator-associated pneumonia (VAP) from three different institutions in Barcelona (B), Montevideo (M), and Seville (S). The observations were compared with the findings reported by Trouillet and coworkers (AJRCCM 1998;157:531-539) in Paris (P). The objective was to evaluate whether a classification of etiologies of VAP in four groups, based on the number of ventilation days and previous antimicrobial use, might contribute to establishing generalized guidelines for empirical therapy. Significant variations in etiologies (p < 0.05) were found in all of the microorganisms isolated from VAP episodes across three treatment sites when compared with the reference site (P). In Group 1 (< 7 d and absence of antibiotics), Pseudomonas aeruginosa remained extremely infrequent (3 of 89, 3.3%) in the joint category, whereas the incidence of Acinetobacter baumannii was significantly higher, owing to M findings. On the other hand, one site (B) had a significantly lower incidence of multiresistant pathogens (Methicillin-resistant Staphylococcus aureus [MRSA] and nonfermenters other than P. aeruginosa), even in Group 2 (< 7 d and antibiotics), Group 3 (>/= 7 d and absence of antibiotics), and Group 4 (antibiotics and >/= 7 days). Similar findings were documented when episodes were grouped according to Groups 1 and 3 of the ATS guidelines. We conclude that causes of VAP varied markedly across four treatment sites, resulting in the need for large-scale variations in antimicrobial prescribing practices. Instead of following general recommendations, antimicrobial prescribing practices for VAP should be based on up-to-date information of the pattern of multiresistant isolates from each institution.

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Background: For some time now, the effects of sound, noise, and music on the human body have been studied. However, despite research done through time, it is still not completely clear what influence, interaction, and effects sounds have on human body. That is why it is necessary to conduct new research on this topic. Thus, in this paper, a systematic review is undertaken in order to integrate research related to several types of sound, both pleasant and unpleasant, specifically noise and music. In addition, it includes as much research as possible to give stakeholders a more general vision about relevant elements regarding methodologies, study subjects, stimulus, analysis, and experimental designs in general. This study has been conducted in order to make a genuine contribution to this area and to perhaps to raise the quality of future research about sound and its effects over ECG signals.Methods: This review was carried out by independent researchers, through three search equations, in four different databases, including: engineering, medicine, and psychology. Inclusion and exclusion criteria were applied and studies published between 1999 and 2017 were considered. The selected documents were read and analyzed independently by each group of researchers and subsequently conclusions were established between all of them.Results: Despite the differences between the outcomes of selected studies, some common factors were found among them. Thus, in noise studies where both BP and HR increased or tended to increase, it was noted that HRV (HF and LF/HF) changes with both sound and noise stimuli, whereas GSR changes with sound and musical stimuli. Furthermore, LF also showed changes with exposure to noise.Conclusion: In many cases, samples displayed a limitation in experimental design, and in diverse studies, there was a lack of a control group. There was a lot of variability in the presented stimuli providing a wide overview of the effects they could produce in humans. In the listening sessions, there were numerous examples of good practice in experimental design, such as the use of headphones and comfortable positions for study subjects, while the listening sessions lasted 20 min in most of the studies.