Utility of Selective Digestive Decontamination in Mechanically Ventilated Patients|

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Abstract

Objective

To assess selective digestive decontamination for preventing nosocomial pneumonia and mortality in mechanically ventilated patients.

Design

Prospective, randomized, placebo-controlled, double-blind study.

Setting

Respiratory intensive care unit of a 1000-bed teaching hospital.

Patients

80 patients receiving mechanical ventilation for more than 72 hours.

Interventions

Patients received selective digestive decontamination using polymyxin E, tobramycin, and amphotericin B through a nasogastric tube and also topically in the oropharynx; control patients received placebo. All patients received intravenous cefotaxime for 4 days or other systemic antibiotics if required.

Measurements

Bacteriologic surveillance (three times a week) was done by quantitatively culturing tracheal aspirates, pharyngeal swabs, and gastric juice. The diagnosis of pneumonia was based on quantitative cultures of protected specimen brush samples (>=103 CFU/mL (colony forming units/mL)) or bronchoalveolar lavage fluid (>=104 CFU/mL) and autopsy findings.

Results

Bronchial, oropharyngeal, and gastric colonization by gram-negative bacilli and Candida species was lower in the selective digestive decontamination group compared with the placebo group. Nonsignificant differences were found in the incidence of nosocomial infections (28% compared with 37%; odds ratio, 0.66; 95% CI, 0.35 to 1.25) and nosocomial pneumonia (18% compared with 24%; odds ratio, 0.7; CI, 0.33 to 1.46) and in the crude mortality rate (31% compared with 27%; odds ratio, 1.21; CI, 0.63 to 2.34) when comparing digestive decontamination with placebo, respectively.

Conclusions

Selective digestive decontamination in our mechanically ventilated patients significantly decreased the colonization rate of gram-negative bacilli and of Candida species but not of Staphylococcus aureus. It did not decrease the incidence of nosocomial pneumonia, mortality, length of stay, or the duration of mechanical ventilation.

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