Effect of a probiotic preparation (VSL#3) in critically ill patients: A randomized, double-blind, placebo-controlled trial (Pilot Study)

Ebrahimi-Mameghani, Mehrangiz; Sanaie, Sarvin; Mahmoodpoor, Ata; Hamishehkar, Hadi

doi:10.12669/pjms.292.3370

Cited by 32 publications

(36 citation statements)

References 32 publications

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“… EN (standard) 27 Lopez de Toro 2014 [ 23 ] Medical and surgical ICU patients with multi-organ failure n = 89 C.Random: yes ITT: yes Blinding: no Score: 11 Viability (intervention): NR EN EN + symbiotic drink with streptococcus Thermophilus, lactobacillus bulgaricus , Lactobacillus casei , lactobacillus acidophilus , bifidobacterium , Escherichia coli , coliformes × 7 days (max 4.8 × 10 9 UFC/ml). EN and PN 28 Sanaie 2014 [ 24 ] Critically ill pts, SIRS, expected length of stay ≥7 days n = 40 C.Random: yes ITT: yes Blinding: double Score: 9 Viability (intervention): yes NG tube EN (standard) + 2 sachets VSL#3 BID × 7 days. EN (standard) + placebo 29 Rongrungruang 2015 [ 25 ] Critically ill patients, expected to receive mechanical ventilation at least 72 h and had no VAP at enrollment n = 150 C.Random: no ITT: no Blinding: no Score: 6 Viability (intervention): yes EN 80 ml of 8 × 10 9 cfu of Lactobacillus casei (Shirota strain) (Yakult) for oral care after the standard oral care once daily An additional 80 ml of the product was given via enteral feeding once daily for 28 days or when their endotracheal tubes were removed EN (standard) + oral care with 2 % chlorhexidine solution 4 times per day 30 Zeng 2016 [ 26 ] Critically ill patients, expected to receive mechanical ventilation at least 48 h n = 235 C.Random: yes ITT: no Blinding: no Score: 5 Viability (intervention): yes NG tube 1 capsule (Medilac-S, China) 0.5 g three times daily.…”

Section: Resultsmentioning

confidence: 99%

Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis

et al. 2016

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BackgroundCritical illness is characterized by a loss of commensal flora and an overgrowth of potentially pathogenic bacteria, leading to a high susceptibility to nosocomial infections. Probiotics are living non-pathogenic microorganisms, which may protect the gut barrier, attenuate pathogen overgrowth, decrease bacterial translocation and prevent infection. The purpose of this updated systematic review is to evaluate the overall efficacy of probiotics and synbiotic mixtures on clinical outcomes in critical illness.MethodsComputerized databases from 1980 to 2016 were searched. Randomized controlled trials (RCT) evaluating clinical outcomes associated with probiotic therapy as a single strategy or in combination with prebiotic fiber (synbiotics). Overall number of new infections was the primary outcome; secondary outcomes included mortality, ICU and hospital length of stay (LOS), and diarrhea. Subgroup analyses were performed to elucidate the role of other key factors such as probiotic type and patient mortality risk on the effect of probiotics on outcomes.ResultsThirty trials that enrolled 2972 patients were identified for analysis. Probiotics were associated with a significant reduction in infections (risk ratio 0.80, 95 % confidence interval (CI) 0.68, 0.95, P = 0.009; heterogeneity I2 = 36 %, P = 0.09). Further, a significant reduction in the incidence of ventilator-associated pneumonia (VAP) was found (risk ratio 0.74, 95 % CI 0.61, 0. 90, P = 0.002; I2 = 19 %). No effect on mortality, LOS or diarrhea was observed. Subgroup analysis indicated that the greatest improvement in the outcome of infections was in critically ill patients receiving probiotics alone versus synbiotic mixtures, although limited synbiotic trial data currently exists.ConclusionProbiotics show promise in reducing infections, including VAP in critical illness. Currently, clinical heterogeneity and potential publication bias reduce strong clinical recommendations and indicate further high quality clinical trials are needed to conclusively prove these benefits.

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Section: Resultsmentioning

confidence: 99%

Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis

et al. 2016

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“…At the same time, emerging data have shown that probiotics can secrete metabolites and factors with immunomodulatory properties [24,48,64]. For example, relevant studies demonstrated a decrease in proinflammatory cytokines using multistrain probiotic supplementation [21,65,66]. The novelty in our study was that we used an inexpensive food (and easily produced at home) to reduce serum proinflammatory cytokines and possibly contribute to neuroprotective effect in AD patients.…”

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confidence: 98%

Oxidative Stress and Dementia in Alzheimer’s Patients: Effects of Synbiotic Supplementation

Ton

Campagnaro

Alves

et al. 2020

Oxidative Medicine and Cellular Longevity

122

110

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Background. Alzheimer’s disease (AD) is the most common cause of dementia in elderly patients. Recently, several studies have shown that inflammation and oxidative stress precede the cardinal neuropathological manifestations of AD. In view of the proven antioxidant effects of probiotics, we proposed that continuous dietary supplementation with milk fermented with kefir grains might improve cognitive and metabolic and/or cellular disorders in the AD patients. Methods. This study was designed as an uncontrolled clinical investigation to test the effects of probiotic-fermented milk supplementation (2 mL/kg/daily) for 90 days in AD patients exhibiting cognitive deficit. Cognitive assessment, cytokine expression, systemic oxidative stress levels, and blood cell damage biomarkers were evaluated before (T0) and after (T90) kefir synbiotic supplementation. Results. When the patients were challenged to solve 8 classical tests, the majority exhibit a marked improvement in memory, visual-spatial/abstraction abilities, and executive/language functions. At the end of the treatment, the cytometric analysis showed an absolute/relative decrease in several cytokine markers of inflammation and oxidative stress markers (⋅O2–, H2O2, and ONOO−, ~30%) accompanied by an increase in NO bioavailability (100%). In agreement with the above findings by using the same technique, we observed in a similar magnitude an improvement of serum protein oxidation, mitochondrial dysfunction, DNA damage/repair, and apoptosis. Conclusion. In conclusion, we demonstrated that kefir improves cognitive deficits, which seems to be linked with three important factors of the AD—systemic inflammation, oxidative stress, and blood cell damage—and may be a promising adjuvant therapy against the AD progression.

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“…Results showed no significant difference between groups in terms of the mean energy intake (1503.75±231.6 vs. 1617.5±185.51, p= 0.09). The percentage of patients who met energy requirements in the synbiotic and placebo groups was 84.98±3.6 and 87.24±3.92 respectively (p=0.06) (26).…”

Section: Effect On Energy Intakementioning

confidence: 92%

Effect of gut microbiota modulation on feeding tolerance of enterally-fed critically ill adult patients: a systematic review

Seifi

Esfahani

Sedaghat

et al. 2020

Preprint

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Purpose The objective of this systematic review was to evaluate the effect of pre-, pro-, and synbiotics on feeding tolerance of enterally-fed critically ill adult patients. Methods Medline, Science Direct, Web of Knowledge, and the Cochrane Central Register of Controlled Trials were searched up to November 2019. English language randomized controlled trials reporting the effect of pre, pro or synbiotics on the feeding tolerance of enterally-fed critically ill adult patients were included. Results Among six studies reporting the energy intake, only two studies showed significantly higher energy intake in the prebiotic-receiving groups. Among four RCTs reporting frequency or time to achieve the target calorie, only one found a significant effect of probiotics to reduce the time to achieve a target dose of calorie. About the prevalence or duration of diarrhea, 7 out of 12 RCTs reported a beneficial effect. All but one study found no beneficial effects for gut microbiota manipulation on clinical endpoints including LOS in hospital and ICU. Conclusion It should be noticed that the heterogeneity in study designs, product format, and ICU patient populations makes it difficult to draw any general conclusion. Overall, it seems that pre, pro or synbiotics have not significant beneficial effect on feeding tolerance and clinical endpoints in critically ill adults, but they may reduce the prevalence or duration of diarrhea.

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Effect of a probiotic preparation (VSL#3) in critically ill patients: A randomized, double-blind, placebo-controlled trial (Pilot Study)

Cited by 32 publications

References 32 publications

Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis

Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis

Oxidative Stress and Dementia in Alzheimer’s Patients: Effects of Synbiotic Supplementation

Effect of gut microbiota modulation on feeding tolerance of enterally-fed critically ill adult patients: a systematic review

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