Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT)

Litton, Edward; Anstey, Matt; Broadhurst, David; Chapman, Andy R.; Currie, Andrew; Ferrier, Janet; Gummer, Joel; Higgins, Alisa; Lim, Jolene; Manning, Laurens; Myers, Erina; Orr, Katrina; Palermo, Anne Marie; Paparini, Andrea; Pellicanò, S; Raby, Edward; Rammohan, Anu; Regli, Adrian; Richter, Bernhard; Salman, Sam; Strunk, Tobias; Waterson, Sharon; Weight, David; Wibrow, Bradley; Wood, Fiona

doi:10.1007/s00134-020-06322-w

Cited by 22 publications

(19 citation statements)

References 24 publications

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“…While no benefits for clinical outcome parameters were found, reduced prevalence or duration of diarrhea episodes were observed [ 65 ]. A very recent RCT including 218 patients did not confirm a significant difference in infectious complications [ 66 ].…”

Section: “What?”—formula Considerationsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

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Section: “What?”—formula Considerationsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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“…Furthermore, in the subgroup analyses of the 5 RCTs [ 14 , 33 , 37 , 39 , 44 ] that administered synbiotics, there was a significant reduction in the incidence of ICU-acquired infections (RR = 0.72; 95% CI: 0.58–0.89, p = 0.0007, I 2 = 79%). However, in 7 trials [ 18 , 26 , 27 , 38 , 40 , 43 , 45 ] that administered probiotics alone, there was no effect on infections (RR = 0.96; 95% CI: 0.87–1.07, p = 0.48; I 2 = 37%). These results also confirmed the incidence of sepsis.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

Wang

Zeng

et al. 2022

Burns &Amp; Trauma

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Background Microbial dysbiosis in critically ill patients is a leading cause of mortality and septic complications. Probiotics and synbiotics have emerged as novel therapy on gut microbiota to prevent septic complications. However, current evidence on their effects is conflicting. This work aims to systematically review the impact of probiotics or synbiotics in critically ill adult patients. Methods A comprehensive search of the PubMed, CBM, Embase, CENTRAL, ISI, and CNKI databases was performed to identify randomized controlled trials that evaluate probiotics or synbiotics in critically ill patients. The quality assessment was based on the modified Jadad's score scale and the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The major outcome measure was mortality. Secondary outcomes included incidence of septic complications, sepsis incidence, length of intensive care unit (ICU) stay, incidence of non-septic complication, and ventilator day. Data synthesis was conduct by Review Manager 5.4. Results A total of 25 randomized controlled trials reporting on 5049 critically ill patients were included. In the intervention group, 2520 participants received probiotics or synbiotics, whereas 2529 participants received standard care or placebo. Pooling data from randomized controlled trials demonstrated a significant reduction in the incidence of ventilator-associated pneumonia (VAP) in the treatment group [(risk ratio (RR) 0.86; 95% confidence interval (CI): 0.78–0.95; p < 0.003, I2 = 85%)]. However, in the subgroup analysis, the reduction of incidence of VAP was only significant in patients receiving synbiotics (RR = 0.61, 95% CI: 0.47–0.80, p = 0.0004, I2 = 40%) and not significant in those receiving only probiotics (RR = 0.91, 95% CI: 0.82–1.01, p = 0.07, I2 = 65%). Moreover, sepsis incidence of critically ill patients was only significantly reduced by the addition of synbiotics (RR = 0.41; 95% CI: 0.22–0.72, p = 0.005, I2 = 0%). The incidence of ICU-acquired infections was significantly reduced by the synbiotics therapy (RR = 0.72; 95% CI: 0.58–0.89, p = 0.0007, I2 = 79%). There was no significant difference in mortality, diarrhea, or length of ICU stay between the treatment and control groups. Conclusions Synbiotics is an effective and safe nutrition therapy in reducing septic complications in critically ill patients. However, in such patients, administration of probiotics alone compared with placebo resulted in no difference in the septic complications.

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“…While the prevention of VAP has been the main focus in probiotic research, several other outcome measures have also been investigated including diarrhea, other infections, length of hospital stay and mortality. A recent placebo-controlled randomized controlled trial in 218 Australian ICU patients by Litton et al assessed the effect of early daily Lactobacillus plantarum 299v supplementation [ 59 ]. The primary outcome was days alive and out of hospital to day 60, a composite endpoint of death, hospital length of stay and hospital re-admissions.…”

Section: Microbiome Modulation In the Icumentioning

confidence: 99%

“…The primary outcome was days alive and out of hospital to day 60, a composite endpoint of death, hospital length of stay and hospital re-admissions. Early and sustained administration of L. plantarum 299v did not improve the primary outcome measure (49.5 (IQR 37–53) in the probiotic group and 49 (IQR 43.8–53) in the placebo group, p = 0.55) [ 59 ]. Several subgroup analyses, including the evaluation of antibiotic treatment, the presence of sepsis and type of ICU admission, did not reveal significant differences either.…”

Section: Microbiome Modulation In the Icumentioning

confidence: 99%

Probiotics in the Intensive Care Unit

2022

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The understanding of the gut microbiome in health and disease has shown tremendous progress in the last decade. Shaped and balanced throughout life, the gut microbiome is intricately related to the local and systemic immune system and a multitude of mechanisms through which the gut microbiome contributes to the host’s defense against pathogens have been revealed. Similarly, a plethora of negative consequences, such as superinfections and an increased rate of hospital re-admissions, have been identified when the gut microbiome is disturbed by disease or by the iatrogenic effects of antibiotic treatment and other interventions. In this review, we describe the role that probiotics may play in the intensive care unit (ICU). We discuss what is known about the gut microbiome of the critically ill, and the concept of probiotic intervention to positively modulate the gut microbiome. We summarize the evidence derived from randomized clinical trials in this context, with a focus on the prevention of ventilator-associated pneumonia. Finally, we consider what lessons we can learn in terms of the current challenges, efficacy and safety of probiotics in the ICU and what we may expect from the future. Throughout the review, we highlight studies that have provided conceptual advances to the field or have revealed a specific mechanism; this narrative review is not intended as a comprehensive summary of the literature.

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Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT)

Cited by 22 publications

References 24 publications

Nutrition in the Intensive Care Unit—A Narrative Review

Nutrition in the Intensive Care Unit—A Narrative Review

Efficacy of probiotics or synbiotics for critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

Probiotics in the Intensive Care Unit

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