Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial.

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.

[Importance of monitoring theophylline and caffeine plasma levels in the management of neonatal apnea]. / Necesidad de monitorizar los niveles plasmáticos de teofilina y cafeína en el tratamiento de la apnea de los neonatos.

The simultaneous determination of caffeine and theophylline plasmatic levels has been proposed when the later is used in the treatment of the newborn's apnea. The caffeine plasmatic levels have been measured in five premature newborns treated with theophylline and the percentage of caffeine respect of theophylline, appraising its possible clinic repercusion. All the patients obtained theophylline levels into the therapeutic range proposed and a good efficacy was obtained without toxicity data, but there were a great interindividual variation in the amount of caffeine derived from theophylline (range from 12 to 50%). This result suggests the convenience of monitoring both drugs, especially when toxicity appear with theophylline levels into the therapeutic range.