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The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients:a multicenter randomized controlled trial.

Stoutenbeek, Chris and van Saene, Hendrik and Little, Rod and Whitehead, Anne (2007) The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients:a multicenter randomized controlled trial. Intensive Care Medicine, 33 (2). pp. 261-270.

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Abstract

Objective Evaluation of selective decontamination of the digestive tract (SDD) on late mortality in ventilated trauma patients in an intensive care unit (ICU). Methods A multicenter, randomized controlled trial was undertaken in 401 trauma patients with Hospital Trauma Index-Injury Severity Score of 16 or higher. Patients were randomized to control (n = 200) or SDD (n = 201), using polymyxin E, tobramycin, and amphotericin B in throat and gut throughout ICU treatment combined with cefotaxime for 4 days. Primary endpoint was late mortality excluding early death from hemorrhage or craniocerebral injury. Secondary endpoints were infection and organ dysfunction. Results Mortality was 20.9% with SDD and 22.0% in controls. Overall late mortality was 15.3% (57/372) as 29 patients died from cerebral injury, 16 SDD and 13 control. The odds ratio (95% confidence intervals) of late mortality for SDD relative to control was 0.75 (0.40–1.37), corresponding to estimates of 13.4% SDD and 17.2% control. The overall infection rate was reduced in the test group (48.8% vs. 61.0%). SDD reduced lower airway infections (30.9% vs. 50.0%) and bloodstream infections due to aerobic Gram-negative bacilli (2.5% vs. 7.5%). No difference in organ dysfunction was found. Conclusion This study demonstrates that SDD significantly reduces infection in multiple trauma, although this RCT in 401 patients was underpowered to detect a mortality benefit.

Item Type: Article
Journal or Publication Title: Intensive Care Medicine
Subjects:
Departments: Faculty of Science and Technology > Mathematics and Statistics
ID Code: 52190
Deposited By: ep_importer_pure
Deposited On: 21 Dec 2011 10:26
Refereed?: Yes
Published?: Published
Last Modified: 09 Apr 2014 22:59
Identification Number:
URI: http://eprints.lancs.ac.uk/id/eprint/52190

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