Selective Digestive Decontamination Attenuates Organ Dysfunction in Critically Ill Burn Patients
Lucía López-Rodríguez1, Miguel A de la Cal, Paloma García-Hierro
1*Critical Care Department, Hospital Universitario de Getafe, Madrid, Spain †CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain ‡Department of Microbiology, Hospital Universitario de Getafe, Madrid, Spain §Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain ||Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK ¶Universidad Europea, Madrid, Spain.
Objective:
To evaluate whether selective decontamination of the digestive tract (SDD) attenuates organ dysfunction in critically ill burn patients.
Background:
The effect of SDD on the development and progression of organ dysfunction, as an important determinant of mortality in burned patients, is still unknown. We asked whether organ dysfunction is mitigated by treatment with SDD.
Methods:
Patients with burns >20% of total body surface or suspected inhalation injury from a randomized placebo-controlled trial were analyzed to determine the relationship between treatment received (placebo or SDD) and the severity of organ dysfunction as measured by the area under the curve of the Sequential Organ Failure Assessment (SOFA) score (and its individual components) from day 1 to day 7 of admission.
Results:
One hundred seven patients (53 in the SDD group and 54 in the placebo group) were included. Survival was significantly higher in SDD-treated patients (48 of 53, 90.6%) than in placebo-treated patients (39 of 54, 72.2%, P = 0.013). Total (P < 0.01) and respiratory (P < 0.01), cardiovascular (P = 0.04) and hematological (not reaching statistical significance, P = 0.07) organ dysfunction was associated with mortality after adjusting for predicted mortality. In multivariate logistic regression, SDD treatment was independently associated with total (P < 0.01), respiratory (P = 0.02), and hematological (P < 0.01) dysfunction over the first week postinjury.
Conclusions:
The beneficial effect of SDD on mortality in critically ill burned patients is accompanied by a reduction in the degree of organ dysfunction. SDD seems to be a valuable therapeutic strategy to prevent organ dysfunction and, more specifically, respiratory and hematological dysfunction in severely ill burn patients.
Insights
Selective decontamination of the digestive tract (SDD) significantly reduces organ dysfunction and improves survival in critically ill burn patients. This therapeutic strategy is valuable for preventing respiratory and hematological dysfunction post-injury.
Area of Science:
- Critical care medicine
- Burn injury management
- Gastrointestinal tract decontamination
Background:
- Organ dysfunction is a key determinant of mortality in burn patients.
- The impact of selective decontamination of the digestive tract (SDD) on organ dysfunction in this population remains unclear.
- This study investigates whether SDD mitigates organ dysfunction in critically ill burn patients.
Purpose of the Study:
- To evaluate the effect of SDD on organ dysfunction in critically ill burn patients.
- To determine if SDD attenuates the severity and progression of organ dysfunction.
- To assess the relationship between SDD treatment and organ dysfunction outcomes.
Main Methods:
- A randomized placebo-controlled trial was conducted.
- Patients with extensive burns or inhalation injury were analyzed.
- Organ dysfunction was measured using the Sequential Organ Failure Assessment (SOFA) score from day 1 to day 7.
Main Results:
- Survival was significantly higher in the SDD group (90.6%) compared to the placebo group (72.2%).
- SDD treatment was independently associated with reduced total, respiratory, and hematological dysfunction within the first week post-injury.
- While cardiovascular dysfunction showed a trend, respiratory and hematological dysfunction were significantly mitigated by SDD.
Conclusions:
- Selective decontamination of the digestive tract (SDD) reduces organ dysfunction in critically ill burn patients.
- SDD is a valuable therapeutic strategy for preventing organ dysfunction, particularly respiratory and hematological dysfunction.
- The beneficial effects of SDD on mortality are accompanied by a reduction in organ dysfunction severity.
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