Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Myburgh:2022:10.1001/jama.2022.17927,
author = {Myburgh, JA and Seppelt, IM and Goodman, F and Billot, L and Correa, M and Davis, JS and Gordon, AC and Hammond, NE and Iredell, J and Li, Q and Micallef, S and Miller, J and Mysore, J and Taylor, C and Young, PJ and Cuthbertson, BH and Finfer, SR},
doi = {10.1001/jama.2022.17927},
journal = {JAMA: Journal of the American Medical Association},
pages = {1911--1921},
title = {Effect of selective decontamination of the digestive tract on hospital mortality in critically Ill patients receiving mechanical ventilation a randomized clinical trial},
url = {http://dx.doi.org/10.1001/jama.2022.17927},
volume = {328},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Importance  Whether selective decontamination of the digestive tract (SDD) reduces mortality in critically ill patients remains uncertain.Objective  To determine whether SDD reduces in-hospital mortality in critically ill adults.Design, Setting, and Participants  A cluster, crossover, randomized clinical trial that recruited 5982 mechanically ventilated adults from 19 intensive care units (ICUs) in Australia between April 2018 and May 2021 (final follow-up, August 2021). A contemporaneous ecological assessment recruited 8599 patients from participating ICUs between May 2017 and August 2021.Interventions  ICUs were randomly assigned to adopt or not adopt a SDD strategy for 2 alternating 12-month periods, separated by a 3-month interperiod gap. Patients in the SDD group (n = 2791) received a 6-hourly application of an oral paste and administration of a gastric suspension containing colistin, tobramycin, and nystatin for the duration of mechanical ventilation, plus a 4-day course of an intravenous antibiotic with a suitable antimicrobial spectrum. Patients in the control group (n = 3191) received standard care.Main Outcomes and Measures  The primary outcome was in-hospital mortality within 90 days. There were 8 secondary outcomes, including the proportion of patients with new positive blood cultures, antibiotic-resistant organisms (AROs), and Clostridioides difficile infections. For the ecological assessment, a noninferiority margin of 2% was prespecified for 3 outcomes including new cultures of AROs.Results  Of 5982 patients (mean age, 58.3 years; 36.8% women) enrolled from 19 ICUs, all patients completed the trial. There were 753/2791 (27.0%) and 928/3191 (29.1%) in-hospital deaths in the SDD and standard care groups, respectively (mean difference, −1.7% [95% CI, −4.8% to 1.3%]; odds ratio, 0.91 [95% CI, 0.82-1.02]; P = .12). Of 8 prespecified secondary outcomes, 6 showed no significant differences. In the SDD vs
AU  - Myburgh,JA
AU  - Seppelt,IM
AU  - Goodman,F
AU  - Billot,L
AU  - Correa,M
AU  - Davis,JS
AU  - Gordon,AC
AU  - Hammond,NE
AU  - Iredell,J
AU  - Li,Q
AU  - Micallef,S
AU  - Miller,J
AU  - Mysore,J
AU  - Taylor,C
AU  - Young,PJ
AU  - Cuthbertson,BH
AU  - Finfer,SR
DO  - 10.1001/jama.2022.17927
EP  - 1921
PY  - 2022///
SN  - 0098-7484
SP  - 1911
TI  - Effect of selective decontamination of the digestive tract on hospital mortality in critically Ill patients receiving mechanical ventilation a randomized clinical trial
T2  - JAMA: Journal of the American Medical Association
UR  - http://dx.doi.org/10.1001/jama.2022.17927
UR  - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000876648400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://jamanetwork.com/journals/jama/fullarticle/2798011
UR  - http://hdl.handle.net/10044/1/101358
VL  - 328
ER  -
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