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Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial
W Lingnau1, J Berger, F Javorsky
1Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens-University of Innsbruck, Austria.
The Journal of Trauma
|April 1, 1997
Summary
Selective intestinal decontamination did not improve outcomes in trauma patients, failing to reduce rates of pneumonia, sepsis, or death. Bacterial overgrowth may not be the primary driver of complications in this population.
Area of Science:
- Critical Care Medicine
- Infectious Disease Prevention
- Trauma Management
Background:
- Selective intestinal decontamination (SID) aims to reduce pathogens in intensive care settings.
- Its efficacy in homogeneous trauma populations remains under-researched despite scientific interest.
Purpose of the Study:
- To evaluate the effectiveness of SID in non-infected trauma patients requiring prolonged mechanical ventilation.
- To compare two different topical decontamination regimens against a placebo.
Main Methods:
- A prospective, controlled study randomized 310 trauma patients into three groups: PTA, PCA, or placebo.
- Topical agents were administered to the oropharynx and gastrointestinal tract four times daily.
- All patients received intravenous ciprofloxacin for 4 days.
Main Results:
- SID successfully reduced intestinal bacterial colonization in all treated groups.
- No significant differences were observed in rates of pneumonia, sepsis, multiple organ failure, or mortality between groups.
- The PTA regimen incurred the highest patient costs.
Conclusions:
- Selective intestinal decontamination offers no discernible benefit for trauma patients.
- Bacterial overgrowth in the intestinal tract is likely not the sole factor linking trauma, sepsis, and organ failure.