Probiotics: A Little Help for Enteral Nutritional Therapy in Critically Ill Adults

The administration of enteral nutritional therapy (ENT), combined with the use of probiotics, is considered a proactive therapeutic strategy that can modulate the intestinal microbiota, resulting in beneficial effects on intestinal integrity and function, as well as on the immune system of patients. This review aimed to find evidence on the clinical effects of probiotic administration in treating patients using ENT. An integrative search was performed to select scientific articles on the use of probiotics in ENT published in the last 10 years (2014-2025) using PubMed, ScienceDirect, Scielo, and Google Scholar databases. The descriptors used in the search were "probiotics" AND "enteral nutrition" OR "tube feeding" AND "adults" AND "critical illness". Retrospective studies, pilot single/double-blind placebo-controlled clinical trials, and randomized trials investigating the effects of probiotic supplementation in enteral nutrition were included. A review of 21 manuscripts was conducted, in which all patients received ENT with probiotics, with 14 monitored in the ICU, 4 in the ward, and 3 at home. All 21 studies reviewed included a control group using enteral nutrition alone or a placebo, and some also included the study of other treatments. All studies demonstrated clinical benefits of some nature for patients who received enteral nutrition associated with the use of probiotics, such as reduced hospitalization time, improvement in the gastrointestinal tract, reduction in diarrhea associated with the use of antibiotics and inflammatory and immunological responses, and reduction in the incidence of pneumonia associated with mechanical ventilation. Probiotic supplementation in adult patients using enteral nutritional therapy demonstrates benefits that help promote health and improve intestinal microbiota composition. No side effects or adverse risks have been reported.