TY - JOUR
T1 - Selective digestive tract decontamination in critically ill adults with acute brain injuries
T2 - a post hoc analysis of a randomized clinical trial
AU - Young, Paul J.
AU - Devaux, Anthony
AU - Li, Qiang
AU - Billot, Laurent
AU - Davis, Joshua S.
AU - Delaney, Anthony
AU - Finfer, Simon R.
AU - Hammond, Naomi E.
AU - Micallef, Sharon
AU - Seppelt, Ian M.
AU - Venkatesh, Balasubramanian
AU - Myburgh, John A.
AU - the SuDDICU Australia Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
AU - Gordon, Anthony
AU - Cuthbertson, Brian
AU - Fowler, Robert
AU - Murthy, Srinivas
AU - Pattison, Natalie
AU - Iredell, Jon
AU - Taylor, Colman
AU - Young, Duncan
AU - van der Poll, Tom
AU - Roberts, Ian
AU - Boschert, Catherine
AU - Broadfield, Emma
AU - Chimunda, Timothy
AU - Fletcher, Jason
AU - Knott, Cameron
AU - Porwal, Sanjay
AU - Smith, Julie
AU - Bhonagiri, Deepak
AU - Leijten, Monique
AU - Narayan, Sandhya
AU - Sanchez, David
AU - Saunders, Peta
AU - Sherriff, Carli
AU - Barrett, Jonathan
AU - Hanlon, Gabrielle
AU - Jelly-Butterworth, Sarah
AU - O’Donnell, Julie
AU - Watson, Judith
AU - Bihari, Shailesh
AU - Brown, Julia
AU - Comerford, Sharon
AU - Laver, Russell
AU - McIntyre, JoAnne
AU - Shrestha, Tapaswi
AU - Xia, Jin
AU - Bates, Samantha
AU - Fennessy, Gerard
AU - French, Craig
N1 - Publisher Copyright: © 2023, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Purpose: The aim of this study was to determine whether selective decontamination of the digestive tract (SDD) reduces in-hospital mortality in mechanically ventilated critically ill adults admitted to the intensive care unit (ICU) with acute brain injuries or conditions. Methods: We carried out a post hoc analysis from a crossover, cluster randomized clinical trial. ICUs were randomly assigned to adopt or not to adopt a SDD strategy for two alternating 12-month periods, separated by a 3-month inter-period gap. Patients in the SDD group (n = 2791; 968 admitted to the ICU with an acute brain injury) received a 6-hourly application of an oral paste and administration of a gastric suspension containing colistin, tobramycin, and nystatin for the duration of mechanical ventilation, plus a 4-day course of an intravenous antibiotic with a suitable antimicrobial spectrum. Patients in the control group (n = 3191; 1093 admitted to the ICU with an acute brain injury) received standard care. The primary outcome was in-hospital mortality within 90 days. There were four secondary clinical outcomes: death in ICU, ventilator-, ICU- and hospital-free days to day 90. Results: Of 2061 patients with acute brain injuries (mean age, 55.8 years; 36.4% women), all completed the trial. In patients with acute brain injuries, there were 313/968 (32.3%) and 415/1093 (38%) in-hospital deaths in the SDD and standard care groups (unadjusted odds ratio [OR], 0.76, 95% confidence interval [CI] 0.63–0.92; p = 0.004). The use of SDD was associated with statistically significant improvements in the four clinical secondary outcomes compared to standard care. There was no significant heterogeneity of treatment effect between patients with and without acute brain injuries (interaction p = 0.22). Conclusions: In this post hoc analysis of a randomized clinical trial in critically ill patients with acute brain injuries receiving mechanical ventilation, the use of SDD significantly reduced in-hospital mortality in patients compared to standard care without SDD. These findings require confirmation.
AB - Purpose: The aim of this study was to determine whether selective decontamination of the digestive tract (SDD) reduces in-hospital mortality in mechanically ventilated critically ill adults admitted to the intensive care unit (ICU) with acute brain injuries or conditions. Methods: We carried out a post hoc analysis from a crossover, cluster randomized clinical trial. ICUs were randomly assigned to adopt or not to adopt a SDD strategy for two alternating 12-month periods, separated by a 3-month inter-period gap. Patients in the SDD group (n = 2791; 968 admitted to the ICU with an acute brain injury) received a 6-hourly application of an oral paste and administration of a gastric suspension containing colistin, tobramycin, and nystatin for the duration of mechanical ventilation, plus a 4-day course of an intravenous antibiotic with a suitable antimicrobial spectrum. Patients in the control group (n = 3191; 1093 admitted to the ICU with an acute brain injury) received standard care. The primary outcome was in-hospital mortality within 90 days. There were four secondary clinical outcomes: death in ICU, ventilator-, ICU- and hospital-free days to day 90. Results: Of 2061 patients with acute brain injuries (mean age, 55.8 years; 36.4% women), all completed the trial. In patients with acute brain injuries, there were 313/968 (32.3%) and 415/1093 (38%) in-hospital deaths in the SDD and standard care groups (unadjusted odds ratio [OR], 0.76, 95% confidence interval [CI] 0.63–0.92; p = 0.004). The use of SDD was associated with statistically significant improvements in the four clinical secondary outcomes compared to standard care. There was no significant heterogeneity of treatment effect between patients with and without acute brain injuries (interaction p = 0.22). Conclusions: In this post hoc analysis of a randomized clinical trial in critically ill patients with acute brain injuries receiving mechanical ventilation, the use of SDD significantly reduced in-hospital mortality in patients compared to standard care without SDD. These findings require confirmation.
KW - Acute brain injury
KW - Mechanical ventilation
KW - Mortality
KW - Selective decontamination of the digestive tract
UR - http://www.scopus.com/inward/record.url?scp=85177061604&partnerID=8YFLogxK
U2 - 10.1007/s00134-023-07261-y
DO - 10.1007/s00134-023-07261-y
M3 - Article
C2 - 37982826
SN - 0342-4642
VL - 50
SP - 56
EP - 67
JO - Intensive care medicine
JF - Intensive care medicine
IS - 1
ER -