[Selective digestive decontamination].

Abstract

OBJECTIVES: The objectives of the study were: to explain our protocol of selective digestive decontamination (SDD); to know the therapeutic activity that the protocol implies in the nursing staff; to assess the impact on the incidence of ventilatorassociated pneumonia. METHODS DESIGN: Prospective descriptive study for time measurements, and non randomized comparative study for the incidence of ventilatorassociated pneumonia. We calculate time means and 95 percent confidence interval (CI). We calculate ventilatorassociated pneumonia relative risk and number-needed-to-treat (NNT). SETTING: Intensive care unit with 13 beds reference for neurocritical illness. STUDY PERIOD: Control group from November-2001 to April-2002. Treatment group from May-2002 to November 2002. PATIENTS: consecutive patients who were admitted in our intensive care department with mechanical ventilation for more than 48 hours.Results. A total of 122 consecutive patients were included: control group 62 patients, treatment group 60 patients. We have recorded 136 SDD administration time and 16 vigilance culture records. The SDD administration mean time was 8.11 minutes (95% CI, 7.59-8.63). Morning Nursing Duty Schedule spent significantly more time mean 10.7 minutes (95% CI, 9.87- 11.89) than afternoon 8.1 (95% CI, 7.20-9.08) (p < 0.05) and night 6.9 (95% CI, 6.39-7.46). There was a significant difference between time spent in SDD administration in trauma patients (p < 0.05) 7.45 (95% CI, 6.63-8.27) and medical patients 8.71 minutes (95% CI, 8.41-9.01). We spent a mean of 9 minutes (CI 8-10) in culture sampling. In the treatment group the ventilator associated pneumonia incidence relative risk was 0.28 (CI 0.13-0.63) with a NNT of 4 (CI 3-8). CONCLUSION: In our patients SDD administration represents the 2.5% of our therapeutic activity time per patient and reduces the ventilator associated pneumonia risk.