Selective Decontamination of the Digestive Tract in Adult Mechanically Ventilated Patients - An Updated Systematic...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Uncertainty exists regarding the efficacy of selective decontamination of the digestive tract (SDD) in reducing mortality for mechanically ventilated ICU patients.
• Previous meta-analyses have not incorporated recent randomized clinical trial (RCT) data.
• The need for an updated systematic review and meta-analysis to clarify SDD's impact on mortality is recognized.

Purpose of the Study:

• To determine if selective decontamination of the digestive tract (SDD) reduces hospital mortality compared to standard care in adult ICU patients on mechanical ventilation.
• To update a previous meta-analysis with contemporary RCT data.
• To provide a robust statistical estimate of SDD's effect on mortality.

Main Methods:

• An updated systematic review and meta-analysis of published randomized clinical trials (RCTs) was performed.
• Searches were conducted for trials comparing SDD to standard care in mechanically ventilated adult ICU patients.
• Data were pooled using a Bayesian framework, with hospital mortality as the primary outcome.

Main Results:

• The analysis included 32 RCTs with 27,687 participants; 30 RCTs contributed to the primary outcome.
• The pooled relative risk for hospital mortality with SDD versus standard care was 0.91 (95% credible interval: 0.82 to 0.99).
• There was a 99.2% posterior probability that SDD was associated with lower hospital mortality.

Conclusions:

• There is a high probability that selective decontamination of the digestive tract (SDD) reduces in-hospital mortality in mechanically ventilated adults in the ICU.
• SDD represents a potentially beneficial antimicrobial strategy for this patient population.
• The findings support the use of SDD as a preventive measure against mortality in the ICU.