Question 14 from the second paper of 2013 and the identical Question 22 from the second paper of 2017
Multiple CICM Second Part SAQs have asked asks for a substantial amount of detail regarding SDD. Fortunately, they are all basically identical questions.
A quick answer to "critically evaluate the role of SDD" can be found in the Discussion section there.
Below is a summary of recent evidence for SDD, scraped together from the following sources:
Oh's Manual mentions SDD only in brief, in the context of preventing liver transplant complications, and preventing bacterial translocation from the gut in severe acute pancreatitis.
The whole point of SDD is to prevent nosocomial infection caused by the translocation of gastrointestinal microbes out of the GI tract and into areas where they dont belong.
In brief:
The beneficial effects are expected to manifest in the following ways:
With such criticism levelled at the current (extensive) body of evidence, one wonders what sort of multiplanetary interspecies triple-blinded trial would be required to defeat the doubts of the sceptics.
One such trial is currently cooking - it is the SuDDICU trial by the CCCTG.
Of it, one of the principal investigators, Ian Seppelt, writes for the Crit IQ blog:
"... Our goal is to do not just the next (37th) RCT for the next Cochrane metaanalysis, but to do the DEFINITIVE trial which answers the question, one way or the other...we will be using a mixture of nystatin, colistin and tobramycin orally and enterally... we will need up to 50,000 patients over a number of years."
This has great promise, because it could potentially represent a substantial mortality benefit from the use of a fairly simple (and cheap) routine measure. Time will tell.
Marshall, John C. "Gastrointestinal flora and its alterations in critical illness."Current Opinion in Critical Care 5.2 (1999): 119.
van Saene, H. K. F., et al. "Microbial gut overgrowth guarantees increased spontaneous mutation leading to polyclonality and antibiotic resistance in the critically ill." Current drug targets 9.5 (2008): 419-421.
Camus, Christophe, et al. "Short-Term Decline in All-Cause Acquired Infections With the Routine Use of a Decontamination Regimen Combining Topical Polymyxin, Tobramycin, and Amphotericin B With Mupirocin and Chlorhexidine in the ICU: A Single-Center Experience*." Critical care medicine 42.5 (2014): 1121-1130.
Daneman, Nick, et al. "Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis." The Lancet infectious diseases 13.4 (2013): 328-341.
Price, Richard, Graeme MacLennan, and John Glen. "Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis." BMJ: British Medical Journal 348 (2014).
Petros, Andy J., et al. "2B or Not 2B for Selective Decontamination of the Digestive Tract in the Surviving Sepsis Campaign Guidelines." Critical care medicine 41.11 (2013): e385-e386.
Hurley, James C. "Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base." Crit Care15 (2011): R7.
Ochoa-Ardila, María E., et al. "Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study." Intensive care medicine 37.9 (2011): 1458-1465.
Hurley, James C. "The perfidious effect of topical placebo: A calibration of Staphylococcus aureus Ventilator Associated Pneumonia incidence within Selective Digestive Decontamination (SDD) studies versus the broader evidence base." Antimicrobial agents and chemotherapy (2013): AAC-00424.
Liberati, Alessandro, et al. "Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care." Cochrane Database Syst Rev 1 (2004).
Safdar, Nasia, Adnan Said, and Michael R. Lucey. "The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: A systematic review and meta‐analysis." Liver transplantation10.7 (2004): 817-827.
Derde, L. P. G., and M. J. M. Bonten. "Controlling antibiotic resistance in intensive care units." Netherlands Journal of Critical Care, VOLUME 19 - NO 1 - FEBRUARY 2015
De Smet, A. M. G. A., et al. "Decontamination of the digestive tract and oropharynx in ICU patients." New England Journal of Medicine 360.1 (2009): 20.
Cuthbertson, B. H., et al. "A study of the perceived risks, benefits and barriers to the use of SDD in adult critical care units (The SuDDICU study)." Trials 11.1 (2010): 117.