In the ever-evolving field of clinical nutrition, the utilization of probiotics and synbiotics to improve patient outcomes in critical care has piqued the interest of healthcare professionals worldwide. A new systematic review and meta-analysis published in “Clinical Nutrition ESPEN” has shed light on the efficacy of these interventions in critically ill patients, revealing significant benefits, including a reduction in the incidence of ventilator-associated pneumonia (VAP) and sepsis.

The systematic review and meta-analysis, helmed by a team from the Burn Department, Ningbo No. 2 Hospital, Zhejiang Province, China, rigorously evaluated data retrieved from major databases like PubMed, Embase, the Cochrane Database, and the Web of Science. With the primary output measure being the incident of ventilator-associated pneumonia, the study also scrutinized secondary outcomes such as diarrhea, Clostridium difficile infection (CDI), the incidence of sepsis, hospital-acquired pneumonia, mechanical exploitation duration, ICU mortality rate, length of ICU stay, in-hospital mortality, and length of hospital stay.

The research incorporated data from 33 individual studies, with a total patient enrollment of 4065 in the treatment group who received either probiotics or synbiotics, while the control group of 3821 patients received standard care or a placebo. Strikingly, the pooled data elucidated a substantial reduction in the incidence of ventilator-associated pneumonia in the treatment group (Relative Risk (RR) = 0.80; 95% Confidence Interval (CI): 0.67-0.96; p = 0.021).

Moreover, the analysis demonstrated that probiotic and synbiotic supplements significantly reduced the incidence of sepsis and pared down the duration of mechanical exploitation, length of hospital and ICU stays, as well as ICU mortality. However, the intervention had a minimal impact on diarrhea, CDI, the incidence of hospital-acquired pneumonia, and in-hospital mortality in this patient demographic.

The findings from the systematic review and meta-analysis present compelling evidence suggesting that probiotic and synbiotic supplementation could be a vital adjunct in the management of critically ill patients, enhancing their recovery process and outcomes.

The study authors, including Jiaqi Lou, Shengyong Cui, Neng Huang, Guoying Jin, Cui Chen, Youfen Fan, Chun Zhang, and Jiliang Li, acknowledge financial support from the Medical Scientific Research Foundation of Zhejiang Province and the Project of NINGBO Leading Medical & Health Discipline. Their research, which faced no competing interests, was first received on July 17, 2023, revised on October 9, 2023, and accepted on November 1, 2023, and is now published in the February 2024 edition of “Clinical Nutrition ESPEN.”

With the DOI 10.1016/j.clnesp.2023.11.003, this study is poised to inform and guide clinical practices in the field of critical care nutrition, potentially leading to enhanced patient care protocols in ICUs around the globe.

The search for optimal nutritional strategies for critically ill patients continues, as this robust analysis sheds light on the potential of probiotics and synbiotics. As healthcare providers consider incorporating these supplements into their critical care practice, the implications of this research are far-reaching. It could prompt a change in the clinical guidelines and improve the standard of care for patients fighting life-threatening conditions.

References

1. Lou, J., Cui, S., Huang, N., Jin, G., Chen, C., Fan, Y., Zhang, C., & Li, J. (2024). Efficacy of probiotics or synbiotics in critically ill patients: A systematic review and meta-analysis. Clinical Nutrition ESPEN, 59, 48-62. doi: 10.1016/j.clnesp.2023.11.003
2. Hickson, M. (2018). Probiotics in the prevention of antibiotic-associated diarrhea and Clostridium difficile infection. Therapeutic Advances in Gastroenterology, 4(3), 185-197.
3. Manzanares, W., Lemieux, M., Langlois, P. L., & Wischmeyer, P. E. (2016). Probiotic and synbiotic therapy in critical illness: A systematic review and meta-analysis. Critical Care, 20, 262.
4. Zhao, X., Zhang, Z., Hu, B., Huang, W., Yuan, C., & Zou, L. (2019). Probiotics for Preventing Ventilator-Associated Pneumonia. Cochrane Database of Systematic Reviews, 10(CD009066).
5. Barraud, D., Blard, C., Hein, F., Marçon, O., Cravoisy, A., Nace, L., et al. (2010). Probiotics in the critically ill patient: A double-blind, randomized, placebo-controlled trial. Intensive Care Medicine, 36, 1540-1547.

Keywords

1. Probiotics in Critical Care
2. Synbiotics for ICU Patients
3. Ventilator-Associated Pneumonia Reduction
4. Sepsis Prevention in Critically Ill
5. ICU Nutrition and Probiotics