RCT

SuDDICU

Selective Decontamination of the Digestive Tract during Ventilation in the ICU

N Engl J Med, 2026 · International cluster-crossover randomized trial across ICUs in Australia and Canada

Clinical question

Does selective digestive decontamination reduce hospital mortality in mechanically ventilated ICU patients?

Population: Critically ill adults receiving mechanical ventilation
Intervention: Selective decontamination of the digestive tract
Comparator: Standard care
Primary outcome: In-hospital death by 90 days
Result: In the full international analysis, in-hospital mortality was not significantly reduced with SDD (27.9% vs 29.5%; OR 0.94, 95% CI 0.84–1.05). Ecologic antimicrobial-resistance findings require cautious interpretation.

What the trial found

SDD did not significantly reduce in-hospital mortality.

Current guideline position

Use established VAP-prevention practices; SDD remains context-dependent rather than a universal bundle component.

Clinical interpretation

Do not present SDD as a routine mortality-improving VAP-prevention strategy; potential infection/ecologic effects must be balanced with local antimicrobial-resistance considerations.

Clinical Context & Relevant Topics (2)

Disease Reference

Ventilator-Associated Pneumonia (VAP)

Quantitative lower tract sampling (ETA vs BAL), rapid multiplex PCR panels and stewardship interpretation, PK/PD extended beta-lactams, 7-day duration, and the SHEA prevention bundle.

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Invasive Mechanical Ventilation

Complete clinical topic overview. For the full 10-level interactive course, visit Master MV. Covers core ventilator modes, respiratory mechanics (Cstat, Raw, driving pressure), waveform dyssynchrony analysis, VILI prevention, and liberation protocols.

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