What is it about?
People resuscitated after a cardiac arrest outside hospital are admitted to intensive care, put on a ventilator and cooled to protect the brain. They are at high risk of pneumonia, especially ventilator-associated pneumonia (VAP). Selective digestive decontamination (SDD) - giving non-absorbable antibiotics to the mouth and gut to reduce harmful bacteria - is used in some intensive care units, but remains controversial. We studied 169 consecutive cardiac arrest survivors in the Trieste intensive care unit, all treated with temperature management and SDD. Only 5.3% developed VAP and 9.5% other pneumonias, lower than usually reported. VAP was more likely in men, in patients with heart disease, in those whose white blood cells rose by more than 30% over five days and in those whose throat was colonized by bacteria.
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Why is it important?
Pneumonia is one of the most frequent complications after cardiac arrest and can worsen recovery. The low rate of VAP observed in this cohort suggests that SDD may help prevent it, and regular throat swabs could identify the patients at highest risk. These findings support further, larger studies of SDD in this specific population.
Perspectives
SDD divides the infectious diseases community, mainly because of concerns about antibiotic resistance. These data from our intensive care colleagues in Trieste, led by Erik Roman-Pognuz, add useful evidence for a high-risk group of patients, and show how microbiological surveillance can guide prevention.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Incidence and Risk Factors of Ventilator‐Associated Pneumonia in Cardiac Arrest in Patients With Selective Digestive Decontamination, Critical Care Research and Practice, January 2025, Wiley,
DOI: 10.1155/ccrp/7669466.
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