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Background This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g., driving pressure), complications, and care settings—for example, case volume of ventilated patients, size/type of intensive care unit (ICU), and type of hospital (university/non-university hospital). To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis. Results Of the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals (39.3% vs 57.5%; p  = 0.012). Treatment in non-university hospitals was independently associated with increased mortality (OR (95% CI): 2.89 (1.31–6.38); p  = 0.008). This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures (OR 1.10; 1 cmH 2 O increments) were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure (PEEP) (mean ± SD: 11.7 ± 4.7 vs 9.7 ± 3.7 cmH 2 O; p  = 0.005) and lower driving pressures (15.1 ± 4.4 vs 17.0 ± 5.0 cmH 2 O; p  = 0.02) were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long (median (IQR): 16 (9–29) vs 8 (3–16) days; p  < 0.001). Conclusions Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals.

Recently, it was proposed that solubleintercellular adhesion molecule (sICAM)-1 plasma levels may allowsubgroup identification of patients at risk for cardiovascularcomplications during sepsis. However, the impact of preexistingcoronary artery disease (CAD) on these results has not yet been tested. The aim of this study was to investigate whether plasma levels of adhesion molecules, nitric oxide, and cytokines differ between septicpatients with or with out preexisting CAD. Prospective study. Surgical ICU. Forty-four septic patients, 24 of whom met thecriteria of CAD. Hemodynamic measurementswere performed and blood samples were taken with in 12 h afteronset of sepsis (early sepsis) and again 72 h thereafter (latesepsis). Soluble adhesion molecules and cytokines were determined usingcommercially available enzyme-linked immunosorbent assay kits, cyclicguanosinomonophosphate (cGMP) by competitive radioimmunoassay, and nitrite/nitrate photometrically by Griess reaction. In CAD patients, sICAM-1 (p < 0.02) wassignificantly elevated in early and late sepsis, whereas solubleendothelial-linked adhesion molecule (sE-selectin; p < 0.01) and cGMP (p < 0.03) were only increased in late sepsis. Oxygenconsumption did not significantly differ between groups. Oxygendelivery and mixed venous oxygen saturation during early and latesepsis were significantly diminished and the oxygen extraction ratiosignificantly increased in the CAD group (p < 0.05). Increased endothelial injury may be indicatedby the elevated levels of sICAM-1, sE-selectin, and cGMP in septicpatients with preexisting CAD. These parameters, however, failed toserve as predictors for unknown CAD or chances for survival in earlysepsis.

The Apollo Advanced Telecommunications Computing Architecture (ATCA) platform is an open-source design consisting of a generic \"Service Module\" (SM) and a customizable \"Command Module\" (CM), allowing for cost-effective use in applications such as the readout of the inner tracker and the Level-1 track trigger for the CMS Phase-II upgrade at the HL-LHC. The SM integrates an intelligent IPMC, robust power entry and conditioning systems, a powerful system-on-module computer, and flexible clock and communication infrastructure. The CM is designed around two Xilinx Ultrascale+ FPGAs and high-density, high-bandwidth optical transceivers capable of 25 Gb/s. Crates of Apollo blades are currently being tested at Boston University, Cornell University, and CERN.