Selective digestive decontamination is a prophylactic strategy to reduce infectious morbidity and mortality in critically ill patients.
2 meta-analyses and a recent randomized controlled trial demonstrated a mortality reduction varying between 20% and 40% but this technique has never been properly evaluated in severely burned patients.
Dr de La Cal and colleagues designed a randomized, double blind, placebo controlled, single-center trial.
The researchers aimed to evaluate whether selective digestive decontamination reduces mortality from any cause, and the incidence of pneumonia among patients with severe burns.
The team enrolled patients with burns equal to or less than 20% of total body surface and/or suspected inhalation injury.
The incidence of pneumonia was significantly higher in the placebo group
|Annals of Surgery|
Patients were assigned to receive selective digestive decontamination or placebo for the total duration of treatment in the burn intensive care unit.
The investigative team analyzed 107 patients (53 in the selective digestive decontamination group and 54 in the placebo group) out of 117 that were randomized.
The researchers reported that the intensive care unit mortality was 28% in the placebo group and 9% in the selective digestive decontamination group in the burn intensive care unit.
In addition, the team found that treatment with selective digestive decontamination was associated with a significant reduction in mortality.
The research team adjusted for predicted mortality and showed that mortality was reduced both in the burn intensive care unit and in the hospital.
The researchers noted that the incidence of pneumonia was significantly higher in the placebo group
There were 31 and 17 pneumonias per 1,000 ventilation days in placebo and selective digestive decontamination group, respectively.
Dr de La Cal concluded, “Treatment with selective digestive decontamination reduces mortality and pneumonia incidence in patients with severe burns."