Prebiotic prophylaxis of ventilator-associated pneumonia: A randomized clinical trial

Abstract

Introduction: There is evidence of the curing effects of prebiotics in promoting growth of bifid bacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of ventilator-associated pneumonia (VAP). The purpose of this study was to evaluate the effects of administration of a prebiotic, namely fenugreek seeds, on VAP prevention and clinical outcomes in critically ill patients.
 Methods: In this study, 60 mechanically ventilated patients were randomly divided into 2 groups (n=30 per group). Group 1 was given fenugreek seed powder by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were recorded and clinical responses to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted. Data were analyzed via SPSS v.20, using student t-test, chi-square test, repeated measure ANOVA, and Wilcoxon test.
 Result: There was a significant reduction of patients diagnosed with VAP, as well as clostridium difficileassociated diarrhea and some complications of mechanical ventilation, in group 1 when compared to group 2. In addition, improvement in VAP was significantly greater for group 1 as compared with group 2. Mortality rates were not different between the two groups.
 Conclusion: The present study demonstrated that daily diet with fenugreek seeds can be used as an add-on therapy with other medications in prevention of VAP. As a result, the use of fenugreek seeds in the treatment plan of patients undergoing long-term intubation is recommended.

Preventive Effect of Probiotics on Ventilator-Associated Pneumonia: A Meta-analysis of 2428 Patients

“…Five studies also mentioned acid-suppression therapy using a proton pump inhibitor or H 2 antagonist. 8,19,21,27,30 Most studies diagnosed VAP on the basis of the American College of Chest Physician clinical criteria, mainly on imaging suggestive of pneumonia, body temperature, number of white blood cells, a purulent tracheal aspirate, and positive culture of tracheal aspirates occurring after 48 hours of MV, but the criteria for each study were nuanced. Six studies evaluated the safety of probiotics, and none found the presence of adverse reactions with probiotic use.…”

“…The basic information of each study is shown in Table 1, which cumulatively have a publication range of 2006 to 2019. 8,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] These studies included a total of 2428 patients (1201 probiotics and 1227 controls) who received MV from 13 countries in Europe, the United States, Australia, and Asia and consist of 13 single-center and 7 multicenter studies. In most studies, probiotics were administered by nasogastric tube or through oral administration; however, a few used the administration of a slurry to the oropharynx.…”

“…Five studies also mentioned acid-suppression therapy using a proton pump inhibitor or H 2 antagonist. 8,19,21,27,30 Most studies…”

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

“…The use of these therapies to prevent VAP remains highly controversial. Previous randomized controlled trials (RCTs) (14,(34)(35)(36)(37) and meta-analyses (38)(39)(40)(41)(42) based on high-quality RCTs suggested that probiotics, prebiotics, and synbiotics are associated with VAP prevention. Promising data seemed to support that probiotic or prebiotic supplementation is a strategy for preventing VAP.…”

The effectiveness of probiotics as an adjunct therapy in patients under mechanical ventilation: an umbrella systematic review and meta-analysis

“…Numerous studies have shown that probiotic administration in critical care patients has many positive effects, such as preventing infections, MODS, VAP, and ICU-associated diarrhea. [14][15][16][17][18][19] Recent meta-analyses and reviews have evaluated the effect of probiotics on clinical parameters in mechanically ventilated patients. However, their results are controversial, which have led to inconsistent conclusions about the role of probiotics in critical illness.…”