Letters Managing perioperative risk

Selective decontamination of the digestive tract may reduce perioperative risk in elective surgery

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7536 (Published 22 November 2011) Cite this as: BMJ 2011;343:d7536
  1. Andy Petros, consultant intensivist1,
  2. Daphne Roos, consultant surgeon2,
  3. Hendrick van Saene, reader in microbiology3,
  4. Nia Taylor, research assistant3,
  5. Hans Rommes, consultant intensivist4,
  6. Luciano Silvestri, consultant intensivist5
  1. 1Great Ormond Street Hospital, London WC1N 3JH, UK
  2. 2OLVG, Amsterdam, Netherlands
  3. 3University of Liverpool, Liverpool, UK
  4. 4Gelre Hospitals, Apeldoor, Netherlands
  5. 5Gorizia Hospital, Italy
  1. andy.petros{at}gosh.nhs.uk

Pearse and colleagues review numerous medical interventions for their potential in reducing perioperative morbidity and mortality, all of which they admit lack serious evidence base.1 Surprisingly, they did not review selective decontamination of the digestive tract, an effective evidence based prophylaxis against pneumonia in patients requiring treatment in intensive care.

Selective decontamination of the digestive tract is well established and has been assessed in 65 randomised controlled trials and 12 meta-analyses including around 15 000 patients.2 It is an essential component of critical care for patients undergoing major non-cardiac surgery as it improves survival by preventing pneumonia.3 Patients may also derive as much diagnostic benefit from preoperative surveillance cultures of throat and rectum as from cardiopulmonary exercise testing, discussed in detail by Pearse and colleagues. If surveillance samples give positive results for abnormal micro-organisms, such as aerobic Gram negative bacilli, selective decontamination of the digestive tract should be started preoperatively.4

Pearse and colleagues recommend admission to intensive care as part of the multimodal approach to elective perioperative care to improve survival. Therefore selective decontamination of the digestive tract must be included.


Cite this as: BMJ 2011;343:d7536


  • Competing interests: None declared.


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