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Open Access 01-12-2018 | Editorial

Selective decontamination of the digestive tract in critical care: a teenage angst or coming of age issue?

Author: Brian H. Cuthbertson

Published in: Critical Care | Issue 1/2018

Abstract

Selective decontamination of the digestive tract (SDD) has been with us since the early days of our specialty, and in some ways it marks our progression and maturation. How we have dealt with SDD to date ranges from “thorn in our side” to “elephant in the room”. With high quality multi-national studies underway, how we deal with these results will mark our final maturation to adulthood as a specialty.

Adams D. Hitchhikers guide to the galaxy. London: Pan Books; 1979.

Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10:185–92.CrossRef

Price R, MacLennan G, Glen J, on behalf of the SuDDICU collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014;348:g2197.CrossRef

Daneman N, Sarwar S, Fowler RA, Cuthbertson BH, Canada S. Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis. 2012;13(4):1–14.CrossRef

Cuthbertson BH, Campbell MK, Maclennan G, Duncan EM, Marshall AP, Wells EC, et al. Clinical stakeholders' opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units: an international Delphi study. Crit Care. 2013;17:R266.CrossRef

Webster F, Weijer C, Todd L, Grimshaw JM, Marshall AP, Cook D, et al. The ethics of future trials: qualitative analysis of physicians’ decision making. Trials. 2016;17(12):1–8.

Annane D. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862–71.CrossRef

Beale R, Janes JM, Brunkhorst FM, Dobb G, Levy MM, Martin GS, et al. Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry. Crit Care. 2010;14:R102.CrossRef

Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2016;10:CD008367.PubMed

10.

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRef

11.

Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358:111–24.CrossRef

12.

NICE-SUGAR study investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.CrossRef

13.

Deschepper M, Waegeman W, Eeckloo K, Vogelaers D, Blot S. Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intensive Care Med. 2018;44:1017–26.CrossRef

14.

Wittekamp BH, Plantinga NL, Cooper BS, Lopez-Contreras J, Coll P, Mancebo J, et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial. JAMA: The Journal of the American Medical Association; 2018. https://doi.org/10.1001/jama.2018.13765.

15.

Selective Decontamination of the Digestive Tract in Intensive Care Unit Patients (SuDDICU). https://clinicaltrials.gov/ct2/show/NCT02389036. Accessed 17th Sept 2018.

Title: Selective decontamination of the digestive tract in critical care: a teenage angst or coming of age issue?
Author: Brian H. Cuthbertson
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-018-2227-2

ACC 2024 Congress

Springer Medicine

Selective decontamination of the digestive tract in critical care: a teenage angst or coming of age issue?

Abstract

ACC 2024 Congress

Springer Medicine

Abstract

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