Critical Care Medicine: May 25, 2022 - Volume - Issue -
10.1097/CCM.0000000000005580
Objectives:
To determine the safety and efficacy of probiotics or synbiotics on
morbidity and mortality in critically ill adults and children.
Data Sources:
We searched MEDLINE, EMBASE, CENTRAL, and unpublished
sources from inception to May 4, 2021.
Study Selection:
We performed a systematic search for randomized controlled
trials (RCTs) that compared enteral probiotics or synbiotics to
placebo or no treatment in critically ill patients. We screened studies
independently and in duplicate.
Data Extraction:
Independent reviewers extracted data in duplicate. A
random-effects model was used to pool data. We assessed the overall certainty
of evidence for each outcome using the Grading Recommendations Assessment,
Development, and Evaluation approach.
Data Synthesis:
Sixty-five RCTs enrolled 8,483 patients. Probiotics may
reduce ventilator-associated pneumonia (VAP) (relative risk [RR], 0.72; 95% CI,
0.59 to 0.89 and risk difference [RD], 6.9% reduction; 95% CI, 2.7–10.2% fewer;
low certainty), healthcare-associated pneumonia (HAP) (RR, 0.70; 95% CI,
0.55–0.89; RD, 5.5% reduction; 95% CI, 8.2–2.0% fewer; low certainty), ICU
length of stay (LOS) (mean difference [MD], 1.38 days fewer; 95% CI, 0.57–2.19
d fewer; low certainty), hospital LOS (MD, 2.21 d fewer; 95% CI, 1.18–3.24 d
fewer; low certainty), and duration of invasive mechanical ventilation (MD,
2.53 d fewer; 95% CI, 1.31–3.74 d fewer; low certainty). Probiotics probably
have no effect on mortality (RR, 0.95; 95% CI, 0.87–1.04 and RD, 1.1%
reduction; 95% CI, 2.8% reduction to 0.8% increase; moderate certainty). Post
hoc sensitivity analyses without high risk of bias studies negated the effect
of probiotics on VAP, HAP, and hospital LOS.
Conclusions:
Low certainty RCT evidence suggests that probiotics or synbiotics during
critical illness may reduce VAP, HAP, ICU and hospital LOS but probably have no
effect on mortality.
