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

UNSPECIFIED (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. ISSN 1432-1238

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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:
Journal Article
Journal or Publication Title:
Intensive Care Medicine
Uncontrolled Keywords:
/dk/atira/pure/core/keywords/mathsandstatistics/medicalstatistics
Subjects:
?? medical statisticscritical care and intensive care medicine ??
ID Code:
52190
Deposited By:
Deposited On:
21 Dec 2011 10:26
Refereed?:
Yes
Published?:
Published
Last Modified:
15 Jul 2024 12:36