General Critiques to the Concept of SDD

Marcel Dekker, Inc. 270 Madison Avenue, New York, New York 10016 

Since 1984, more than 40 original studies on SDD, four meta-analyses, and several extensive reviews (37-40) have been performed. As shown in Tables 1 to 5, many of the studies differed in the regimens of SDD applied, the populations under study, the methods used for diagnosing VAP, endpoints (e.g., all VAP, late-onset VAP only, VAP caused by gram-negative bacilli, mortality rate), and the study design. 

Selective decontamination of the digestive tract was associated with a significantly lower mortality rate in 4 (45,59,61,62) of 20 studies. In another analysis, SDD seemed to be beneficial in terms of mortality rate for surgical patients only when successful decontamination could be achieved (63). How- 

Total infectious episodes rather than incidence of VAP. 

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