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News

Selective digestive or oropharyngeal decontamination prevents death in general intensive care

A study in this week's publication of the British Medical Journal compares selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care.

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Dr Richard Price and colleagues determined the effect on mortality of selective digestive decontamination, selective oropharyngeal decontamination, and topical oropharyngeal chlorhexidine in adult patients in general intensive care units.

The team compared these interventions with each other in a network meta-analysis.

The research team performed a systematic review, conventional meta-analysis, and network meta-analysis.

Medline, Embase, and CENTRAL were searched to 2012.

Previous meta-analyses, conference abstracts, and key journals were also searched.

The team used pairwise meta-analyses to estimate direct evidence from intervention-control trials, and a network meta-analysis within a Bayesian framework to combine direct and indirect evidence.

The team identified prospective randomized controlled trials that recruited adult patients in general intensive care units and studied selective digestive decontamination, selective oropharyngeal decontamination, or oropharyngeal chlorhexidine compared with standard care or placebo.

Selective digestive decontamination had a favorable effect on mortality, with a direct evidence odds ratio of 0.73.

The team found that the direct evidence odds ratio for selective oropharyngeal decontamination was 0.85.

The researchers observed that chlorhexidine was associated with increased mortality.

When each intervention was compared with the other, both selective digestive decontamination and selective oropharyngeal decontamination were superior to chlorhexidine.

The difference between selective digestive decontamination and selective oropharyngeal decontamination was uncertain.

Dr Price and colleagues conclude, "Selective digestive decontamination has a favorable effect on mortality in adult patients in general intensive care units."

"In these patients, the effect of selective oropharyngeal decontamination is less certain."

"Both selective digestive decontamination and selective oropharyngeal decontamination are superior to chlorhexidine, and there is a possibility that chlorhexidine is associated with increased mortality."

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2197
09 April 2014

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