Microbiome: what intensivists should know

Area of Science:

• Critical care medicine
• Microbiology
• Gastroenterology

Background:

• Critical illness, including sepsis and multiorgan failure, leads to high global mortality and economic costs.
• Emerging evidence links critical illness to dysbiosis: loss of beneficial microbes and overgrowth of pathogenic bacteria.
• This microbial imbalance is associated with adverse patient outcomes in intensive care settings.

Purpose of the Study:

• To provide an evidence-based overview of the microbiome's role in critical illness for intensivists.
• To explore how targeting the microbiome can improve outcomes for Intensive Care Unit (ICU) patients.
• To review current knowledge on microbiota-targeted interventions in critical care.

Main Methods:

• Literature review of studies investigating the microbiome in critical illness.
• Analysis of evidence for microbiota-targeted interventions (prebiotics, probiotics, fecal microbiota transplantation).
• Synthesis of current understanding regarding microbiome modulation in the ICU.

Main Results:

• Critical illness is characterized by significant alterations in the gut microbiome composition.
• Dysbiosis in critical illness is linked to increased inflammation and poorer patient prognoses.
• Microbiota-directed therapies show potential for improving clinical outcomes in the ICU.

Conclusions:

• The microbiome plays a crucial role in the pathophysiology of critical illness.
• Targeting the microbiome represents a promising avenue for novel therapeutic strategies in critical care.
• Further research is needed to elucidate precise mechanisms and optimize clinical application of these interventions.