Taylor N, van Saene H K F, Abella A, Silvestri L, Vucic M, Peric M
Department of Medical Microbiology, University of Liverpool, Reino Unido.
Med Intensiva. 2007 Apr;31(3):136-45. doi: 10.1016/s0210-5691(07)74792-7.
Selective digestive decontamination (SDD) is a prophylactic strategy whose objective is to reduce the incidence of infections, mainly mechanical ventilation associated pneumonia in patients who require intensive cares, preventing or eradicating the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. Fifty-four randomized clinical trials (RCTs) and 9 meta-analysis have evaluated SDD. Thirty eight RCTs show a significant reduction of the infections and 4 of mortality. All the meta-analyses show a significant reduction of the infections and 5 out of the 9 meta-analyses report a significant reduction in mortality. Thus, 5 patients from the ICU with SDD must be treated to prevent pneumonia and 12 patients from the ICU should be treated to prevent one death. The data that show benefit of the SDD on mortality have an evidence grade 1 or recommendation grade A (supported by at least two level 1 investigations). The aim of this review is to explain the pathogeny of infections in critical patients, describe selective digestive decontamination, analyze the evidence available on it efficacy and the potential adverse effects and discuss the reasons published by the experts who advise against the use of SDD, even though it is recognized as the best intervention evaluated in intensive cares to reduce morbidity and mortality of the infections.
选择性消化道去污（SDD）是一种预防性策略，其目标是降低感染发生率，主要是降低需要重症监护的患者中与机械通气相关的肺炎的发生率，预防或根除潜在致病微生物在口咽部和胃肠道的携带状态。已有54项随机临床试验（RCT）和9项荟萃分析对SDD进行了评估。38项RCT显示感染显著减少，4项显示死亡率降低。所有荟萃分析均显示感染显著减少，9项荟萃分析中有5项报告死亡率显著降低。因此，在重症监护病房（ICU）中，必须治疗5例接受SDD的患者以预防肺炎，而要预防1例死亡则需要治疗12例ICU患者。显示SDD对死亡率有益的数据具有1级证据或A类推荐等级（至少有两项1级研究支持）。本综述的目的是解释危重症患者感染的发病机制，描述选择性消化道去污，分析其有效性和潜在不良反应的现有证据，并讨论尽管SDD被认为是重症监护中评估的最佳降低感染发病率和死亡率的干预措施，但反对使用SDD的专家所发表的理由。
