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A Randomized Controlled Trial to Evaluate the Use of Probiotics in Prevention of Ventilator-Associated Pneumonia in Critically Ill ICU Patients
Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident.
Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients.
Settings and Design Randomized control trials.
Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted.
Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test.
Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups.
Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.
Article published online:
02 July 2022
© 2022. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Johnstone J, Meade M, Lauzier F. et al; Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients: a randomized clinical trial. JAMA 2021; 326 (11) 1024-1033
- 2 Zhao J, Li LQ, Chen CY, Zhang GS, Cui W, Tian BP. Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis. ERJ Open Res 2021; 7 (01) 00302-02020
- 3 Batra P, Soni KD, Mathur P. Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials. J Intensive Care 2020; 8: 81 DOI: 10.1186/s40560-020-00487-8.
- 4 Torres A, Niederman MS, Chastre J. et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50 (03) 50 DOI: 10.1183/13993003.00582-2017.
- 5 Metersky ML, Kalil AC. Management of ventilator-associated pneumonia: guidelines. Clin Chest Med 2018; 39 (04) 797-808
- 6 Schreiber MP, Shorr AF. Challenges and opportunities in the treatment of ventilator-associated pneumonia. Expert Rev Anti Infect Ther 2017; 15 (01) 23-32
- 7 Zhang Y, Yao Z, Zhan S. et al. Disease burden of intensive care unit-acquired pneumonia in China: a systematic review and meta-analysis. Int J Infect Dis 2014; 29: 84-90
- 8 Weng H, Li JG, Mao Z. et al. Probiotics for preventing ventilator-associated pneumonia in mechanically ventilated patients: a meta-analysis with trial sequential analysis. Frontiers in. 2017; 9: 8-717
- 9 Kalil AC, Metersky ML, Klompas M. et al; Infectious Diseases Society of America and the American Thoracic Society. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the. Clin Infect Dis 2016; 63 (05) e61-e111
- 10 Bouadma L, Sonneville R, Garrouste-Orgeas M. et al; OUTCOMEREA Study Group. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med 2015; 43 (09) 1798-1806
- 11 Rello J, Riera J, Serrano R. What's new in ventilator-associated pneumonia?. Intensive Care Med 2015; 41 (11) 1954-1956
- 12 Barbier F, Andremont A, Wolff M, Bouadma L. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med 2013; 19 (03) 216-228
- 13 Melsen WG, Rovers MM, Groenwold RH. et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013; 13 (08) 665-671