PURPOSE:Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. METHODS: This study was performed as a double-blind, concealed randomized, placebo-controlled trial in a French medical intensive care unit (ICU). Adult patients mechanically ventilated for a period of more than 48 h received enterally administered probiotics (Ergyphilus, 2 x 10(10) lactic acid bacteria, mostly Lactobacillus rhamnosus GG, once a day) or placebo until successful weaning. RESULTS:A total of 167 patients were included. The two groups were comparable at baseline. The 28-day mortality rates were not different in the probiotic (25.3%) and placebo groups (23.7%). Mortality rates in ICU and at 90 days were also unaffected by the treatment. The incidence of ICU-acquired infections did not differ significantly except for that of catheter-related bloodstream infections that was lowered by probiotics. On a prespecified subgroup analysis, we found a reduction of the 28-day mortality among severe sepsis patients (total n = 101) treated with probiotics (n = 52) with an odds ratio (OR) for death at 0.38 (95% CI 0.16-0.93, p = 0.035). By contrast, probiotics were associated with a higher mortality rate in non-severe sepsis patients (OR 3.09, 95% CI 0.87-11.01, p = 0.08). CONCLUSIONS: Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.
RCT Entities:
PURPOSE: Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. METHODS: This study was performed as a double-blind, concealed randomized, placebo-controlled trial in a French medical intensive care unit (ICU). Adult patients mechanically ventilated for a period of more than 48 h received enterally administered probiotics (Ergyphilus, 2 x 10(10) lactic acid bacteria, mostly Lactobacillus rhamnosus GG, once a day) or placebo until successful weaning. RESULTS: A total of 167 patients were included. The two groups were comparable at baseline. The 28-day mortality rates were not different in the probiotic (25.3%) and placebo groups (23.7%). Mortality rates in ICU and at 90 days were also unaffected by the treatment. The incidence of ICU-acquired infections did not differ significantly except for that of catheter-related bloodstream infections that was lowered by probiotics. On a prespecified subgroup analysis, we found a reduction of the 28-day mortality among severe sepsispatients (total n = 101) treated with probiotics (n = 52) with an odds ratio (OR) for death at 0.38 (95% CI 0.16-0.93, p = 0.035). By contrast, probiotics were associated with a higher mortality rate in non-severe sepsispatients (OR 3.09, 95% CI 0.87-11.01, p = 0.08). CONCLUSIONS: Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.
Authors: Marc Gh Besselink; Hjalmar C van Santvoort; Erik Buskens; Marja A Boermeester; Harry van Goor; Harro M Timmerman; Vincent B Nieuwenhuijs; Thomas L Bollen; Bert van Ramshorst; Ben Jm Witteman; Camiel Rosman; Rutger J Ploeg; Menno A Brink; Alexander Fm Schaapherder; Cornelis Hc Dejong; Peter J Wahab; Cees Jhm van Laarhoven; Erwin van der Harst; Casper Hj van Eijck; Miguel A Cuesta; Louis Ma Akkermans; Hein G Gooszen Journal: Lancet Date: 2008-02-14 Impact factor: 79.321
Authors: Lindsay M Urben; Jennifer Wiedmar; Erica Boettcher; Rodrigo Cavallazzi; Robert G Martindale; Stephen A McClave Journal: Curr Gastroenterol Rep Date: 2014
Authors: Lulong Bo; Jinbao Li; Tianzhu Tao; Yu Bai; Xiaofei Ye; Richard S Hotchkiss; Marin H Kollef; Neil H Crooks; Xiaoming Deng Journal: Cochrane Database Syst Rev Date: 2014-10-25
Authors: J Macher; C Gras Le Guen; A Chenouard; J M Liet; B Gaillard Le Roux; A Legrand; J Mahuet; E Launay; V Gournay; N Joram Journal: Pediatr Cardiol Date: 2016-11-14 Impact factor: 1.655