New insights into pneumonia in patients on prolonged mechanical ventilation: need for a new paradigm addressing dysbiosis

Rello, Jordi; Schrenzel, Jacques; Tejo, Alexandre Mestre

doi:10.36416/1806-3756/e20210198

Cited by 5 publications

(3 citation statements)

References 11 publications

(29 reference statements)

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“…Classical studies of microbiology neglected the roles of resident communities and dynamic interplay played by pathogenic and resident microbes, immune system and the host environment. CAP occurs along with more or less specific modalities linked to immune compromised subjects (post trauma, post transplantation) as well as to ARDS or tuberculosis ( Pettigrew et al, 2021 ; Rello et al, 2021 ). Of course, viruses, notably SARS-CoV-2, and fungi are recognized etiological agents, and non infectious inflammatory lung conditions should not be forgotten in the diagnosis.…”

Section: Acute Pulmonary Infections and Pneumoniamentioning

confidence: 99%

“…General microbiomic patterns in VAP have alpha and beta diversity almost always decrease in mechanically ventilated subjects, whose suffering could be attributed to substantial loss of potentially protective commensals. The colonization by reduced groups of higher pathogenic potential (dysbiosis), not uncommonly including Gram-negative Proteobacteria, presumably of gastrointestinal origin ( Pettigrew et al, 2021 ; Rello et al, 2021 ). Thus, the standard of low bacterial density and high diversity of species is progressively disrupted.…”

Section: Ventilator Associated Pneumonia (Vap)mentioning

confidence: 99%

“…Some advocate certain paradigm shifts. For instance, instead of a disease caused by a single bacterial pathogen acquired through microaspiration, the occurrence of VAP would underscore major lung dysbiosis, enhanced by immune aberrations and variable degrees of pathogen invasion ( Rello et al, 2021 ). For others the emphasis should be on dysbiosis in the upper digestive tract, nominally oropharyngeal communities.…”

Section: Ventilator Associated Pneumonia (Vap)mentioning

confidence: 99%

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Section: Acute Pulmonary Infections and Pneumoniamentioning

confidence: 99%

Section: Ventilator Associated Pneumonia (Vap)mentioning

confidence: 99%

Section: Ventilator Associated Pneumonia (Vap)mentioning

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Probiotic Supplementation Prevents the Development of Ventilator-Associated Pneumonia for Mechanically Ventilated ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Liu

Chen

et al. 2022

Front. Nutr.

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BackgroundVentilator-associated pneumonia (VAP) is one of the common critical complications of nosocomial infection (NI) in invasive mechanically ventilated intensive care unit (ICU) patients. The efficacy of total parenteral nutrition (TPN), enteral nutrition and/or adjuvant peripheral parenteral nutrition (EPN) supplemented with or without probiotic, prebiotic, and synbiotic therapies in preventing VAP among these patients has been questioned. We aimed to systematically and comprehensively summarize all available studies to generate the best evidence of VAP prevention for invasive mechanically ventilated ICU patients.MethodsRandomized controlled trials (RCTs) for the administration of TPN, EPN, probiotics-supplemented EPN, prebiotics-supplemented EPN, and synbiotics-supplemented EPN for VAP prevention in invasive mechanically ventilated ICU patients were systematically retrieved from four electronic databases. The incidence of VAP was the primary outcome and was determined by the random-effects model of a Bayesian framework. The secondary outcomes were NI, ICU and hospital mortality, ICU and hospital length of stay, and mechanical ventilation duration. The registration number of Prospero is CRD42020195773.ResultsA total of 8339 patients from 31 RCTs were finally included in network meta-analysis. The primary outcome showed that probiotic-supplemented EPN had a higher correlation with the alleviation of VAP than EPN in critically invasive mechanically ventilated patients (odds ratio [OR] 0.75; 95% credible intervals [CrI] 0.58–0.95). Subgroup analyses showed that probiotic-supplemented EPN prevented VAP in trauma patients (OR 0.30; 95% CrI 0.13–0.83), mixed probiotic strain therapy was more effective in preventing VAP than EPN therapy (OR 0.55; 95% CrI 0.31–0.97), and low-dose probiotic therapy (less than 1010 CFU per day) was more associated with lowered incidence of VAP than EPN therapy (OR 0.16; 95% CrI 0.04–0.64). Secondary outcomes indicated that synbiotic-supplemented EPN therapy was more significantly related to decreased incidence of NI than EPN therapy (OR 0.34; 95% CrI 0.11–0.85). Prebiotic-supplemented EPN administration was the most effective in preventing diarrhea (OR 0.05; 95% CrI 0.00–0.71).ConclusionProbiotic supplementation shows promise in reducing the incidence of VAP in critically invasive mechanically ventilated patients. Currently, low quality of evidence reduces strong clinical recommendations. Further high-quality RCTs are needed to conclusively prove these findings.Systamatic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020195773], identifier [CRD42020195773].

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New insights into pneumonia in patients on prolonged mechanical ventilation: need for a new paradigm addressing dysbiosis

Cited by 5 publications

References 11 publications

Lung microbiome and origins of the respiratory diseases

Lung microbiome and origins of the respiratory diseases

Impact of air pollution on respiratory microbiome: A narrative review

Probiotic Supplementation Prevents the Development of Ventilator-Associated Pneumonia for Mechanically Ventilated ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

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