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Selective Decontamination in the ICU Lowers 28-Day Mortality Rates
ICU patients undergoing selective decontamination of either the digestive tract or the oropharynx have lower mortality rates at 28 days than those receiving usual care, the New England Journal of Medicine reports.
Dutch researchers enrolled nearly 6000 patients who, they anticipated, would be intubated for longer than 2 days or remain in the ICU for longer than 3 days. The ICUs treated all patients with one of three regimens: selective digestive tract decontamination (4 days of IV cefotaxime plus topical tobramycin, colistin, and amphotericin B in the oropharynx and stomach), selective oropharyngeal decontamination (just the topical drugs), or standard care.
The absolute risk for death by 28 days (the primary endpoint) was about 3 percentage points lower among patients receiving selective decontamination than among those on standard care. The authors calculate that the number needed to treat to prevent one death by day 28 was roughly 30.
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NEJM article (Free abstract; full text requires subscription)
Published in Physician's First Watch January 5, 2009
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