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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 2/2007

01.02.2007 | Original

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

verfasst von: C. P. Stoutenbeek, H. K. F. van Saene, R. A. Little, A. Whitehead, for the Working Group on Selective Decontamination of the Digestive Tract

Erschienen in: Intensive Care Medicine | Ausgabe 2/2007

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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.
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Metadaten
Titel
The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial
verfasst von
C. P. Stoutenbeek
H. K. F. van Saene
R. A. Little
A. Whitehead
for the Working Group on Selective Decontamination of the Digestive Tract
Publikationsdatum
01.02.2007
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 2/2007
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0455-4

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