The effect of selective digestive decontamination to reduce ventilator-associated pneumonia：a systematic review and meta-analysis

Abstract OBJECTIVE To estimate the association between SDD and risk of VAP of critical patients compared with standard care or placebo. METHODS The primary data search was conducted using Pubmed, EMBASE, Cochrane Library, and Web of Science databases until May 2025. Randomized clinical trials recruited ventilated patients comparing SDD versus placebo or standard care were included in analysis. Study selection and data extraction were performed in duplicate. The statistical analysis was conducted with R software using a random-effects model and common-effects model. The primary outcomes were the incidence of VAP and mortality. Subgroups included selective decontamination intervention through oropharyngeal and enteral administration compared with oropharyngeal administration and SDD with intravenous antibiotics compared with SDD without intravenous antibiotics. The secondary outcome included ICU length of stay (LOS), duration of mechanical ventilation (DMV) and acquired infection rate. RESULTS There were 8 randomized clinical trials including 1220 participants (56.5±18.4 years) in the analysis. The pooled estimated risk ratio (RR) of incidence of VAP for SDD compared with standard care or placebo was 0.45 (95% credible interval [CI], 0.35-0.57; I 2 = 27.6%; moderate certainty) with a prediction interval at 0.24 to 0.88, indicating that SDD reduced the incidence of VAP. However, there were no significant associations between SDD and reduced ICU mortality (RR= 0.85; 95% CI, 0.71-1.02), ICU length of stay (RR= -0.97; 95% CI, -3.89-1.94), duration of mechanical ventilation (RR= -0.2; 95% CI, -2.24-1.84) and acquired nosocomial infection (RR= 0.76; 95% CI, 0.57-1.01) when compared with placebo or standard care. CONCLUSIONS Among critical mechanically ventilation adult patients, the use of SDD was associated with lower risk of the onset of VAP compared with standard care or placebo.