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

Abstract

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 Overall, 15 papers were selected for review. 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 length of stay (LOS) in hospital and intensive care unit (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 no significant beneficial effect on feeding tolerance and clinical endpoints in critically ill adults, but they may reduce the prevalence or duration of diarrhea.

The Effects Of Synbiotic Supplementation On Enteral Feeding Tolerance, Protein Homeostasis And Muscle Wasting Of Critically Ill Adult Patients: A Randomized Controlled Trial

“…Although enteral feed volume, energy, and protein intake increased signi cantly during the rst four days in the synbiotic group, the overall changes were not signi cant and there was no difference in the total EN volume and energy or protein intake between the two groups. Our recent systematic review also showed that synbiotic, probiotic or prebiotic does not affect energy intake and feed volume in tube-fed critically ill patients (21). Although, Rushdi et al showed that prebiotic supplementation was associated with signi cantly increased feed volume on day 4 the intervention group (22), which was inconsistent with our results.…”

Gut Microbiome in Anesthesiology and Pain Medicine

“…The full extent of the implications of gut microbiome composition in the intensive care setting is beyond the scope of this review and has been thoroughly discussed elsewhere. [79][80][81] Nevertheless, several examples will be reviewed here.…”

The effects of synbiotic supplementation on enteral feeding tolerance, protein homeostasis, and muscle wasting of critically ill adult patients: a randomized controlled trial

“…Although enteral feed volume, energy, and protein intake increased significantly during the first 4 days in the synbiotic group, the overall changes were not significant, and there was no difference in the total EN volume and energy or protein intake between the two groups. Our recent systematic review also showed that synbiotic, probiotic, or prebiotic does not affect energy intake and feed volume in tube-fed critically ill patients [ 23 ]. Although, Rushdi et al showed that prebiotic supplementation was associated with significantly increased feed volume on day 4 in the intervention group [ 24 ], which was inconsistent with our results.…”