The development of ventilator-associated pneumonia (VAP) requires microbial pathogens to gain access to the lower respiratory tract. The GI and upper respiratory tract are thought to represent the primary source of these pathogens in intubated patients.1 Interruption of this process by preventing colonization with pathogenic organisms represents a potential target for preventing VAP.
A variety of strategies for decontamination of the oropharynx and GI tract have been studied. The most well-studied strategy is that of selective digestive decontamination (SDD). SDD typically involves the application of an antimicrobial paste to the oropharynx, gastric decontamination with nonabsorbed oral antibiotics, and the use of parenteral antibiotics with activity against Gram-negative organisms. Several metaanalyses2,3 have concluded that SDD significantly reduces the incidence of VAP. It may even reduce mortality in certain populations such as trauma and surgical ICU patients.2,3