Selective decontamination of the digestive tract in cardiac surgical patients.

OBJECTIVE

To test the hypothesis that selective decontamination of the digestive tract improves outcome in cardiac surgical patients.

DESIGN

Prospective, consecutive, controlled trial over two 4-month periods.

SETTING

Eight-bed, open-plan postcardiac surgery ICU.

PATIENTS

All patients undergoing cardiac bypass surgery were eligible. Patients requiring endotracheal intubation for greater than 4 days were included in the analysis. In the initial 4 months, 12 (8.5%) of 141 patients required greater than 4 days of intubation. These 12 patients were not treated with selective decontamination of the digestive tract. We therefore used these patients as the control group. In the second 4-month period, 12 (6.6%) of 180 patients were treated with selective decontamination of the digestive tract and formed the study group.

MAIN OUTCOME MEASURES

The primary measure was mortality. Secondary measures included oropharyngeal decontamination and the presence of lower airway infection.

INTERVENTIONS

Cephradine prophylaxis. The study group received every 6 hrs 4 mL orally and 20 mL intragastrically a suspension of antimicrobial agents (tobramycin 80 mg, polymyxin E 100 mg, amphotericin B 500 mg), starting on postoperative day 1. The control group did not receive any oral antimicrobial agents.

RESULTS

Mortality rate was significantly (p less than .05) reduced from eight (66%) of 12 patients in the control group to two (16.7%) of 12 patients in the selective decontamination of the digestive tract group. No differences in oropharyngeal decontamination or lower airway infection rates between the two groups were found.

CONCLUSIONS

There is a reduced mortality rate in patients receiving selective decontamination of the digestive tract. However, the reader should recognize the small sample size studied. A simple suspension of the antimicrobial agents failed to rid the oropharynx of bacteria.