What is new in selective decontamination of the digestive tract?

Selective decontamination of the digestive tract has been proven to prevent severe infections and to reduce mortality in critically ill patients. Historical arguments against its use, like the development of bacterial resistance and the absence of influence on mortality, have not been confirmed.

What is GI tract decontamination?

Gastrointestinal decontamination refers to the practice of functionally removing an ingested toxin from the gastrointestinal (GI) tract in order to decrease its absorption or increase its clearance.

What is SDD in antibiotics?

Selective digestive decontamination (SDD) refers to the prophylactic treatment of selected patients with an oropharyngeal paste and enteral suspension containing antimicrobials (usually tobramycin, colistin and amphotericin B) as well as an intravenous antibiotic during the first 4 days of ICU admission (usually a …

How is gastric lavage done?

Gastric lavage involves placing a tube through the mouth (orogastric) or through the nose (nasogastric) into the stomach. Toxicants are removed by flushing saline solutions into the stomach, followed by suction of gastric contents.

What was the purpose of gastric lavage and activated charcoal?

Activated charcoal is a method of gastric decontamination that is now being recommended for patients who have ingested potentially toxic amounts of poison up to 1 h previously [1]. The effect of charcoal administered more than 1 h after overdose in a clinical setting appears to be uncertain [1, 2].

What are the limitation of gastric lavage?

Contraindications to gastric lavage include ingestion of hydrocarbons because of high aspiration potential, ingestion of corrosive substances, and risk of hemorrhage or GI perforation resulting from pathology or recent surgery.

What toxins does charcoal absorb?

One of the most common uses of activated charcoal is emergency toxin removal in the form of poisoning or overdose. It has been known to adsorb the toxins found in pesticides, mercury, bleach, opium, cocaine, acetaminophen, morphine and alcoholic beverages, to name a few.

What is a gastric lavage procedure?

How do hospitals flush your stomach?

The procedure starts by numbing the throat to reduce irritation. Then, a tube is inserted through the mouth, down the esophagus, and into the stomach. The tube then suctions out the stomach contents like a vacuum.

What is selective decontamination of the digestive tract?

Selective decontamination of the digestive tract (SDD) is an infection prevention measure for intensive care unit (ICU) patients that was proposed more than 30 years ago, and that is currently considered standard of care in the Netherlands, but only used sporadically in ICUs in other countries.

What are the secondary outcomes of selective decontamination?

Secondary outcomes include an ecological assessment and a long-term health economic analysis. Design- international, multicentre, crossover, cluster randomised controlled trial (x-cRCT) of eligible patients in participating ICUs using two 12-month interventional trial periods separated by a 3-month inter-period gap.

How is colistin used in the digestive system?

A six-hourly topical application of 0.5g paste, containing colistin 10mg, tobramycin 10mg and nystatin 125,000 IU, to the buccal mucosa and oropharynx A six-hourly administration of 10 mL of a suspension containing 100 mg colistin, 80 mg tobramycin and 2 x 106 IU nystatin, to the gastrointestinal tract via a gastric/post-pyloric tube