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A four-probiotic preparation for ventilator-associated pneumonia in multi-trauma patients: results of a randomized
Maria Tsilika1, Giannoula Thoma2, Zoi Aidoni2
14th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Insights
Probiotic prophylaxis significantly reduced ventilator-associated pneumonia (VAP) and sepsis incidence in mechanically ventilated patients. This intervention also shortened intensive care unit (ICU) and hospital stays, highlighting its clinical benefit.
Area of Science:
- Critical Care Medicine
- Microbiology
- Gastroenterology
Background:
- Ventilator-associated pneumonia (VAP) poses a significant challenge in intensive care units, with its prevention strategies still under investigation.
- The role of probiotics in preventing VAP has yielded inconclusive results, necessitating further research into their efficacy.
Purpose of the Study:
- To evaluate the effectiveness of a specific probiotic regimen in preventing VAP among multi-trauma patients requiring prolonged mechanical ventilation.
- To assess the impact of probiotic prophylaxis on other infections, sepsis, and hospital/ICU stay durations.
Main Methods:
- A randomized, placebo-controlled study involving multi-trauma patients requiring mechanical ventilation for over 10 days.
- Patients received either a probiotic formula (Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium lactis, Saccharomyces boulardii) or a placebo for 15 days.
- Probiotics were administered via nasogastric tube and oropharyngeal topical application.
Main Results:
- Probiotic administration significantly reduced VAP incidence (11.9% vs. 28.3%, P=0.034) and sepsis incidence (6.8% vs. 24.5%, P=0.016).
- The probiotic group experienced shorter intensive care unit (ICU) stays and overall hospital stays compared to the placebo group.
- Hazard ratio for VAP was 0.34 (95% CI 0.13-0.92); odds ratio for sepsis was 0.22 (95% CI 0.07-0.74).
Conclusions:
- Prophylactic use of this multi-strain probiotic regimen, delivered enterally and topically, effectively reduces VAP and sepsis in mechanically ventilated patients.
- The probiotic intervention positively impacts patient outcomes by decreasing VAP and sepsis rates and shortening ICU and hospital stays.
Abstract:
The role of probiotics in the prevention of ventilator-associated pneumonia (VAP) remains inconclusive. The aim of this study was to assess the efficacy of a probiotic regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, patients expected to require mechanical ventilation for >10 days were assigned at random to receive prophylaxis with a probiotic formula (n=59) or placebo (n=53). The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 [1.75 × 109 colony-forming units (cfu)], Lactobacillus plantarum (0.5 × 109 cfu), Bifidobacterium lactis BB-12 (1.75 × 109 cfu) and Saccharomyces boulardii (1.5 × 109 cfu) in sachets. Each patient received two sachets twice daily for 15 days: one through the nasogastric tube and one spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis, and the duration of hospital stay were the secondary endpoints. Administration of probiotics reduced the incidence of VAP [11.9% vs 28.3%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.13-0.92; P=0.034] and sepsis [6.8% vs 24.5%, odds ratio 0.22, 95% CI 0.07-0.74: P=0.016]. Furthermore, probiotic prophylaxis reduced the time of stay in the intensive care unit (ICU) and the length of hospital stay. The prophylactic use of probiotics with a combination of enteral and topical application to the oropharynx had a positive effect on the incidence of VAP and sepsis, as well as on ICU and total hospital stay in patients receiving protracted mechanical ventilation.
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