在ICU的通风过程中对消化道的选择性消毒
, Brian H Cuthbertson1,2, Laurent Billot3
1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
The New England journal of medicine
|October 29, 2025
概括
消化道选择性消毒 (SDD) 没有降低机械通风患者的死亡率. 这种重症监护室 (ICU) 的干预也没有防止抗生素耐药的生物,尽管减少了血液感染.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 临床试验 临床试验
背景情况:
- 消化道选择性消毒 (SDD) 是一种在重症监护室 (ICU) 减少感染的策略.
- 它对机械通风患者的死亡率和微生物生态的影响需要进一步调查.
- 之前的澳大利亚数据表明,死亡率没有好处,需要进行全面的国际试验分析.
研究的目的:
- 确定SDD是否降低机械通风患者的死亡率.
- 评估SDD对ICU环境中的微生物生态的影响.
- 评估二次临床和微生物学结果.
主要方法:
- 随机对照试验,在澳大利亚和加拿大的ICU中进行生态评估.
- 接受机械呼吸的患者被分配到SDD或标准护理.
- SDD涉及口腔/胃抗菌剂和初始静脉注射抗生素;生态评估监测了所有ICU患者.
主要成果:
- 总共有2万名患者被纳入 (随机试验中9289人,生态评估中10711人).
- 在SDD (27.9%) 和标准护理 (29.5%) 组之间90天住院死亡率没有显著差异 (OR,0.93;P=0.27).
- SDD减少了血流感染 (4.9%与6.8%相比),但没有抗生素耐药性生物体的发展;在生态评估中没有证实耐药性生物体的非劣势性.
结论:
- 消化道的选择性去污染 (SDD) 并没有降低机械通风的危急病患者的住院死亡率.
- 虽然SDD减少了血液感染,但它并没有阻止抗生素耐药生物体的出现.
- 该研究提供了关于SDD在ICU中的临床和生态影响的全面数据.
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