Does Metoprolol Influence the Risk of Exacerbation in a High-risk COPD Patient Population?

related to antibiotic administration, such as Clostridium difficile colitis. The strengths of this trial include a multicenter design with appropriate blinding, the systematic implementation of VAP prevention bundles in both groups, and the use of a blinded adjudication committee for diagnosis of VAP. Furthermore, the study excluded patients with evidence of overt aspiration at the time of endotracheal intubation; inclusion of this population could have increased the benefit seen from antibiotics. Limitations of the trial include the use of an intravenous antibiotic not available in the United States; however, ampicillin-sulbactam (Unasyn) is available in our country and has comparable coverage. As regards applicability, it is plausible to extend these results to out-of-hospital arrest patients with an initial nonshockable rhythm who undergo TTM, but application to an inhospital arrest population is limited by the increased likelihood that these patients will have MDR organisms. In conclusion, a 2-day course of ampicillin-sulbactam in out-of-hospital cardiac arrest patients undergoing targeted temperature management reduces the incidence of early VAP while posing little immediate risk to the patient.