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ABSTRACT: We assessed the impact of the full protocol of selective decontamination of the digestive tract (SDD) using parenteral and enteral antimicrobials on mortality.
A systematic review was performed searching MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, previous meta-analyses, and conferences proceedings. We included all randomized controlled trials (RCTs) comparing the full protocol of SDD, including oropharyngeal and intestinal administration of antibiotics combined with the parenteral component, with no treatment or placebo. The primary end points were overall mortality, mortality attributable to infection, early, and late mortality.
Twenty-one RCTs on 4902 patients were included. Overall mortality was significantly reduced (odds ratio [OR], 0.71; 95% confidence interval [CI]; 0.61-0.82; P < .001). There was a nonsignificant reduction in infection-related mortality (6 RCTs; OR, 0.40; 95% CI, 0.10-1.59; P = .19) and early mortality (4 RCTs; OR, 0.64; 95% CI, 0.34-1.19; P = 0.16), and a significant reduction in late mortality (5 RCTs; OR, 0.56; 95% CI, 0.40-0.77; P < .001). The subgroup analysis showed a significant mortality reduction in successfully decontaminated patients (OR, 0.58; 95% CI, 0.45-0.77; P < .001), and when parenteral and enteral antimicrobials were administered to every patient receiving treatment in the intensive care unit (OR, 0.59; 95% CI, 0.42-0.82; P < .001).
The findings strongly indicated that the full protocol of SDD reduces mortality in critically ill patients, in particular when successful decontamination is obtained. Eighteen patients should be treated with SDD to prevent one death.
Journal of critical care 03/2009; 24(3):474.e7-14. · 2.13 Impact Factor
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ABSTRACT: This report is aimed at identifying and suggesting a decision-making approach to handle old patients in ICUs in the light of current epidemiological findings and literature. We reviewed the data provided by the GIVITI network on 107,459 patients admitted to 150 Italian ICUs between 2000 and 2005; patients were divided into age groups (18-65 years: group I; 66-75 years: group II; 76-85 years: group III; > or =85 years: group IV). Comorbidities were recorded on admission in all groups [I (62.2%), II (92.2%), III (94.9%) and IV (94.5%), respectively]. Therapeutic means were virtually applied in the same way to all groups under examination [I (82.1%), II (83.9%), III (85.9%) and IV (83.5%), respectively]. Mortality in ICU was higher in group IV (27.2%), followed by groups III (24.3%), II (19.1%) and I (13.2%). The multivariate logistic regression analysis of GIVITI and some reviewed studies suggest that age is an independent mortality factor; however, current literature is controversial. The choice of admitting and treating old patients in ICUs should result from a balance between clinical and ethical factors.
Archives of gerontology and geriatrics 01/2009; 49(2):294-7. · 1.36 Impact Factor
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ABSTRACT: Many patients are admitted to the pediatric intensive care unit (PICU) with infection as the primary problem, for example
with viral pneumonitis or meningococcal disease. Other patients are admitted free of infection but are at risk of acquisition,
particularly if their stay in the PICU is prolonged with invasive devices in situ. A further group are admitted with exacerbations
of chronic conditions, where infection may be a contributing factor, for example, pulmonary aspiration in a child with cerebral
palsy.
12/2008: pages 215-230;
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Critical care medicine 10/2008; 36(9):2716-7. · 6.37 Impact Factor
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The Journal of trauma 04/2007; 62(4):1062-4; author reply 1064-5. · 2.48 Impact Factor
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American Journal of Respiratory and Critical Care Medicine 02/2006; 173(1):131-3; author reply 133. · 11.08 Impact Factor
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Critical Care Medicine 03/2005; 33(2):462-3; author reply 463-4. · 6.33 Impact Factor
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Journal of Intensive Care Medicine 22(3):181-2; author reply 183.
