Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

Abstract

Background: Among critically ill patients, regardless of the heterogeneity of disease state, an extreme and persistent dysbiosis occurs. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrients homeostasis disturbances. Methods: This is a prospective, single center, double-blind; a parallel randomized controlled trial that aimed to evaluate the effects of synbiotic supplementation on energy and macronutrient ‎homeostasis and muscle wasting in critical care patients.‎ All eligible patients (20 subjects in each group) will receive standard hospital gavage as enteral nutrition through a nasogastric tube (NGT) in the 24-48h after admission. In the intervention group, patients will receive Lactocare (ZistTakhmir) capsules 500 mg every 12h for 14 days. Patients in the control group will receive a placebo capsule which contains only the sterile maize starch and is similar to synbiotic capsules. The synbiotic and placebo capsules will be given through nasogastric tube, separately from gavage, after feeding. Discussion: Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency and ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism. Trials registration: The trial protocol has been approved in Iranian Registry of Clinical Trials at 2019-03-17. The registration reference is IRCT20190227042857N1.

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

“…We suggest more new well-designed trials that assess feeding tolerance as a primary endpoint with a unified definition and an invariable enteral nutrition protocol that would make it possible to compare the obtained results. We have recently designed an RCT in which the main purpose is to determine the effect of synbiotics on feeding tolerance and energy homeostasis of critically ill adult patients [43]. New trials should aim to demonstrate the beneficial composition of supplements, dose, and duration to have beneficial effects.…”

Secondary Sclerosing Cholangitis in Critically Ill Patients Alters the Gut–Liver Axis: A Case Control Study

“…Further on, they receive multiple medications including antibiotics, antiviral and antifungal therapies and enteric or parenteral nutrition. That all these interventions together with the underlying critical illness alter the microbiome on different body sites has been shown recently, as well as that these changes may trigger hospital-acquired infections, sepsis, multi-organ failure, energy homeostasis disturbance, muscle wasting and cachexia [ 10 , 12 , 13 , 44 , 66 , 67 , 68 ]. One reason for this may be the slower bowel transit time in critically ill patients caused by electrolyte and glucose disturbances as well as by therapeutics like sedatives and opiates [ 66 ].…”

“…One reason for this may be the slower bowel transit time in critically ill patients caused by electrolyte and glucose disturbances as well as by therapeutics like sedatives and opiates [ 66 ]. Therefore, therapeutic efforts with approaches such as probiotics, symbiotics or fecal microbiota transplants have been investigated [ 68 , 69 , 70 , 71 , 72 , 73 , 74 ]. Our cohort of critically ill patients who did not develop SC-CIP had all been discharged from ICU a year before study inclusion on average, but still, taxonomic differences remained on all levels compared to healthy controls.…”

“…In our cohort, we could observe reduced diversity, and on a genus level, also increased abundance of Veillonella compared to healthy controls. This species could cause joint infections, endocarditis and was associated with hepatic encephalopathy [ 66 , 67 , 68 ], but can also be an effect of PPI intake of some cirrhotic patients [ 79 ].…”