SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT - A MEASURE WHOSE TIME HAS PASSED

Selective decontamination of the digestive tract, using a combination of prophylactic topical and parenteral antibiotics, is a strategy that was developed to reduce the risk of ventilator-associated pneumonia i n critically ill patients. Although many of the studies (approximately 40) and four meta-analyses carried out on the subject of selective de contamination of the digestive tract have shown a reduction in the inc idence of pneumonia, no clear effects on mortality have been demonstra ted, and concerns about overgrowth by, and infections with, micro-orga nisms resistant to the antibiotics used in this treatment remain, Inte restingly, there has recently been an increase in the number of public ations on other pharmacological and nonpharmacological methods of infe ction prevention in mechanically ventilated intensive care unit patien ts, such as the use of sucralfate for stress ulcer prophylaxis, the mo dulation of enteral feeding, the suctioning of subglottic secretions a nd avoidance of the aspiration-prone supine positioning of patients, T he results of some of these studies have shown potential benefits. On the basis of a review of the recent literature, the routine use of sel ective decontamination of the digestive tract is still not justified i n intensive care units. Although some of the alternative strategies ha ve shown promising results, more randomized (and double-blind) studies are needed to demonstrate the clinical value of these measures.