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Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial
Cathy Alberda1, Leah Gramlich, Jon Meddings
1Royal Alexandra Hospital, Edmonton, Canada, University of Alberta, Edmonton, Canada.
Background:
Multiple organ dysfunction syndrome (MODS) is a major cause of mortality in intensive care units. A breakdown in gut barrier function and immune dysfunction are associated with the onset of MODS. Probiotic bacteria have been shown to modulate intestinal barrier and immune function.
Objective:
This study assessed the efficacy of a probiotic compound in a viable and nonviable formulation in modulating intestinal permeability and immune function and preventing the onset of MODS in patients in the intensive care unit.
Design:
A double-blind, randomized controlled trial was conducted in the intensive care unit of a tertiary care teaching hospital. Twenty-eight critically ill patients admitted to the intensive care unit were randomly assigned to receive 1 of 3 treatments daily for 7 d: 1) placebo, 2) viable probiotics, or 3) equivalent probiotic sonicates. MODS scores and systemic concentrations of immunoglobulin (Ig) A and IgG were measured on days -1, 4, and 7, and intestinal permeability measurements were taken daily.
Results:
The patients responded to viable probiotics with a significantly larger increase in systemic IgA and IgG concentrations than in the patients who received placebo or sonicates (P < 0.05). MODS scores were not significantly affected by probiotic treatment. Over the study period, intestinal permeability decreased in most patients.
Conclusion:
Patients receiving viable probiotics show a greater enhancement in immune activity than do patients receiving either placebo or probiotic bacterial sonicates.
Insights
Viable probiotics significantly enhanced immune activity, increasing immunoglobulin levels in critically ill patients. While intestinal permeability improved, multiple organ dysfunction syndrome (MODS) scores were not significantly affected by probiotic treatment.
Area of Science:
- Critical care medicine
- Gastroenterology
- Immunology
Background:
- Multiple organ dysfunction syndrome (MODS) is a leading cause of death in intensive care units (ICUs).
- Gut barrier dysfunction and immune dysregulation are implicated in MODS development.
- Probiotics are known to influence intestinal barrier and immune functions.
Purpose of the Study:
- To evaluate the effectiveness of a probiotic in both viable and nonviable forms.
- To assess the modulation of intestinal permeability and immune function.
- To determine the prevention of MODS in ICU patients.
Main Methods:
- A double-blind, randomized controlled trial involving 28 critically ill ICU patients.
- Patients received placebo, viable probiotics, or probiotic sonicates daily for 7 days.
- Measurements included MODS scores, IgA/IgG levels, and daily intestinal permeability.
Main Results:
- Viable probiotics led to a significant increase in systemic IgA and IgG compared to placebo or sonicates (P < 0.05).
- Intestinal permeability showed a general decrease across most patients during the study.
- No significant impact on MODS scores was observed with probiotic interventions.
Conclusions:
- Viable probiotics enhance immune activity more effectively than placebo or nonviable probiotic sonicates.
- Probiotic treatment may modulate intestinal permeability.
- Further research is needed to confirm the impact on MODS prevention.
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