Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

被引：27

作者：

Sharif, Sameer ^{[1
,2
]}

Greer, Alisha ^{[1
,2
]}

Skorupski, Clarissa ^{[3
]}

Hao, Qiukui ^{[4
,5
]}

Johnstone, Jennie ^{[6
,7
]}

Dionne, Joanna C. ^{[2
,8
]}

Lau, Vincent ^{[9
]}

Manzanares, William ^{[10
]}

Eltorki, Mohamed ^{[11
]}

Duan, Erick ^{[2
]}

Lauzier, Francois ^{[12
,13
]}

Marshall, John C. ^{[14
]}

Heels-Ansdell, Diane ^{[8
]}

Thabane, Lehana ^{[8
]}

Cook, Deborah J. ^{[2
,8
]}

Rochwerg, Bram ^{[2
,8
]}

机构：

[1] McMaster Univ, Div Emergency Med, Dept Med, Hamilton, ON, Canada

[2] McMaster Univ, Div Crit Care, Dept Med, Hamilton, ON, Canada

[3] Univ Toronto, Dept Med, Toronto, ON, Canada

[4] Sichuan Univ, West China Hosp, Natl Clin Res Ctr Geriatr, Chengdu, Peoples R China

[5] McMaster Univ, Fac Hlth Sci, Hamilton, ON, Canada

[6] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada

[7] Sinai Hlth, Infect Prevent & Control, Toronto, ON, Canada

[8] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[9] Univ Alberta, Alberta Hlth Serv, Fac Med & Dent, Dept Crit Care Med, Edmonton, AB, Canada

[10] Hosp Clin Montevideo, UdelaR, Fac Med, Dept Crit Care, Montevideo, Uruguay

[11] McMaster Univ, Div Pediat Emergency Med, Dept Pediat, Hamilton, ON, Canada

[12] Univ Laval, Dept Med, Quebec City, PQ, Canada

[13] CHU Quebec, Univ Laval Res Ctr, Trauma Emergency Crit Care Med, Populat Hlth & Optimal Hlth Practice Res Unit, Quebec City, PQ, Canada

[14] Univ Toronto, Unity Hlth Toronto, Dept Crit Care Med, Toronto, ON, Canada

来源：

CRITICAL CARE MEDICINE | 2022年 / 50卷 / 08期

基金：

加拿大健康研究院;

关键词：

clinical trial; critical illness; probiotics; randomized; synbiotics; VENTILATOR-ASSOCIATED PNEUMONIA; EARLY ENTERAL NUTRITION; SEVERE ACUTE-PANCREATITIS; LACTOBACILLUS-PLANTARUM; 299V; ILL PATIENTS; DOUBLE-BLIND; SACCHAROMYCES-BOULARDII; GUT MICROBIOTA; INTENSIVE-CARE; INFECTION;

D O I：

10.1097/CCM.0000000000005580

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVES: To determine the safety and efficacy of probiotics or synbiotics on morbidity and mortality in critically ill adults and children. DATA SOURCES: We searched MEDLINE, EMBASE, CENTRAL, and unpublished sources from inception to May 4, 2021. STUDY SELECTION: We performed a systematic search for randomized controlled trials (RCTs) that compared enteral probiotics or synbiotics to placebo or no treatment in critically ill patients. We screened studies independently and in duplicate. DATA EXTRACTION: Independent reviewers extracted data in duplicate. A random-effects model was used to pool data. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Sixty-five RCTs enrolled 8,483 patients. Probiotics may reduce ventilator-associated pneumonia (VAP) (relative risk [RR], 0.72; 95% CI, 0.59 to 0.89 and risk difference [RD], 6.9% reduction; 95% CI, 2.7-10.2% fewer; low certainty), healthcare-associated pneumonia (HAP) (RR, 0.70; 95% CI, 0.55-0.89; RD, 5.5% reduction; 95% CI, 8.2-2.0% fewer; low certainty), ICU length of stay (LOS) (mean difference [MD], 1.38 days fewer; 95% CI, 0.57-2.19 d fewer; low certainty), hospital LOS (MD, 2.21 d fewer; 95% CI, 1.18-3.24 d fewer; low certainty), and duration of invasive mechanical ventilation (MD, 2.53 d fewer; 95% CI, 1.31-3.74 d fewer; low certainty). Probiotics probably have no effect on mortality (RR, 0.95; 95% CI, 0.87-1.04 and RD, 1.1% reduction; 95% CI, 2.8% reduction to 0.8% increase; moderate certainty). Post hoc sensitivity analyses without high risk of bias studies negated the effect of probiotics on VAP, HAP, and hospital LOS. CONCLUSIONS: Low certainty RCT evidence suggests that probiotics or synbiotics during critical illness may reduce VAP, HAP, ICU and hospital LOS but probably have no effect on mortality.

引用

页码：1175 / 1186

页数：12