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VOLUME 26 , ISSUE 3 ( March, 2022 ) > List of Articles

Systematic Review/Meta-Analysis

Probiotics in Critically Ill Patients: An Umbrella Review

Amirreza Naseri, Sepideh Seyedi-Sahebari, Ata Mahmoodpoor

Keywords : Critical illness, Intensive care units, Probiotics, Systematic review, Umbrella review

Citation Information : Naseri A, Seyedi-Sahebari S, Mahmoodpoor A. Probiotics in Critically Ill Patients: An Umbrella Review. Indian J Crit Care Med 2022; 26 (3):339-360.

DOI: 10.5005/jp-journals-10071-24129

License: CC BY-NC 4.0

Published Online: 30-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Objectives: Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Because of the wide usage of antibiotics, acute changes in diet, and the stress of illness, critically ill patients’ homeostasis of the gut microbiome can be disrupted during intensive care unit (ICU) confinement; probiotics are suggested as a beneficial intervention in critically ill patients. We tried to give an overview of the effects of probiotic supplements in critically ill patients based on published systematic reviews (SRs) and meta-analyses (MAs). Data sources: A systematic search was performed in four databases as well as hand searching. Study selection: The results were independently screened in two title/abstracts and full-text stages. Data extraction: Any reported outcomes in each study were extracted, using a data extraction table. Data synthesis: A wide range of outcomes of using probiotic supplements in critically ill patients have been reported in 20 included studies. Based on the current knowledge, we can say that probiotics may reduce the rate of ventilator-associated pneumonia, nosocomial pneumonia, the overall infection rate, duration of mechanical ventilation, and antibiotic use in critically ill patients, but there is not a significant association between using the probiotics and mortality, length of hospitalization, and incidence of diarrhea. Conclusion: Despite the various beneficial effects of probiotics in critically ill patients, there is not yet much evidence supporting the routine use of these supplements and further well-designed multicenter trials are needed to provide “evidence-based” recommendations.

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  1. Tewari S, David J, Gautam A. A review on probiotic dairy products and digestive health. J Pharmacogn Phytochem 2019;8(3):368–372. Available from: https://www.phytojournal.com/archives/2019/vol8issue3/PartH/8-3-57-432.pdf
  2. FAO/WHO J. Report of a Joint FAO/WHO Working Group on drafting guidelines for the evaluation of probiotics in food. London, Ontario, Canada. April 30 and May 1, 2002. Available from: http://whoint/foodsafety/fs_management/en/probiotic_guidelinespdf.
  3. McFarland LV, Evans CT, Goldstein EJ. Strain-specificity and disease-specificity of probiotic efficacy: a systematic review and meta-analysis. Front Med 2018;5:124. DOI: 10.3389/fmed.2018.00124.
  4. Manzhalii E, Virchenko O, Falalyeyeva T, Beregova T, Stremmel W. Treatment efficacy of a probiotic preparation for non-alcoholic steatohepatitis: a pilot trial. J Dig Dis 2017;18(12):698–703. DOI: 10.1111/1751-2980.12561.
  5. Liang D, Longgui N, Guoqiang X. Efficacy of different probiotic protocols in irritable bowel syndrome: a network meta-analysis. Medicine 2019;98(27):e16068. DOI: 10.1097/MD.0000000000016068.
  6. Santacroce L, Charitos IA, Bottalico L. A successful history: probiotics and their potential as antimicrobials. Expert Rev Anti Infect Ther 2019;17(8):635–645. DOI: 10.1080/14787210.2019.1645597.
  7. Szántó M, Dózsa A, Antal D, Szabó K, Kemény L, Bai P. Targeting the gut-skin axis—probiotics as new tools for skin disorder management? Exp Dermatol 2019;28(11):1210–1218. DOI: 10.1111/exd.14016.
  8. Toh SL, Boswell-Ruys CL, Lee BSB, Simpson JM, Clezy KR. Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database Syst Rev 2017;9(9):CD010723. DOI: 10.1002/14651858.CD010723.pub2.
  9. Rondanelli M, Faliva MA, Perna S, Giacosa A, Peroni G, Castellazzi AM. Using probiotics in clinical practice: where are we now? A review of existing meta-analyses. Gut Microbes 2017;8(6):521–543. DOI: 10.1080/19490976.2017.1345414.
  10. Braga VL, Rocha LPS, Bernardo DD, Cruz CO, Riera R. What do Cochrane systematic reviews say about probiotics as preventive interventions? Sao Paulo Med J 2017;135(6):578–586. DOI: 10.1590/1516-3180.2017.0310241017.
  11. Morrow LE, Wischmeyer P. Blurred lines: dysbiosis and probiotics in the ICU. Chest 2017;151(2):492–499. DOI: 10.1016/j.chest.2016.10.006.
  12. Smith S, Roberts S. Nutrition support in critically ill obese adults. Nurs Crit Care 2015;10(6):26–35. DOI: 10.1097/01.CCN.0000472844.55184.31.
  13. Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med 2012;40(12):3290–3302. DOI: 10.1097/CCM.0b013e318260cc33.
  14. Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med 2010;182(8):1058–1064. DOI: 10.1164/rccm. 200912-1853OC.
  15. Manzanares W, Langlois PL, Wischmeyer PE. Restoring the microbiome in critically ill patients: are probiotics our true friends when we are seriously ill? J Parenter Enteral Nutr 2017;41(4):530–533. DOI: 10.1177/0148607117700572.
  16. Haak BW, Levi M, Wiersinga WJ. Microbiota-targeted therapies on the intensive care unit. Curr Opin Crit Care 2017;23(2):167–174. DOI: 10.1097/MCC.0000000000000389.
  17. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutr Clin Pract 2014;29(1):29–43. DOI: 10.1177/0884533613510948.
  18. McClave SA, Taylor BE, Martindale R, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 2016;40(2): 159–211. DOI: 10.1177/0148607115621863.
  19. Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, et al. Clinical nutrition in critical care medicine–guideline of the German Society for Nutritional Medicine (DGEM). Clin Nutr ESPEN 2019;33:220–275. DOI: 10.1016/j.clnesp.2019.05.002.
  20. Whiting P, Savović J, Higgins JPT, Caldwell DM, Reeves BC, Shea B, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016;69:225–234. DOI: 10.1016/j.jclinepi.2015.06.005.
  21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097.
  22. Fan Q-L, Yu X-M, Liu Q-X, Yang W, Chang Q, Zhang Y-P. Synbiotics for prevention of ventilator-associated pneumonia: a probiotics strain-specific network meta-analysis. J Int Med Res 2019;47(11):5349–5374. DOI: 10.1177/0300060519876753.
  23. Su M, Jia Y, Li Y, Zhou D, Jia J. Probiotics for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Respir Care 2020;65(5):673–685. DOI: 10.4187/respcare.07097.
  24. Siempos II, Ntaidou TK, Falagas ME. Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 2010;38(3):954–962. DOI: 10.1097/CCM.0b013e3181c8fe4b.
  25. Gu W-J, Wei C-Y, Yin R-X. Lack of efficacy of probiotics in preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Chest 2012;142(4):859–868. DOI: 10.1378/chest.12-0679.
  26. Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev 2014;10(10):Cd009066. DOI: 10.1002/14651858.CD009066.pub2.
  27. Barraud D, Bollaert P-E, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest 2013;143(3):646–655. DOI: 10.1378/chest.12-1745.
  28. Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care 2016;20(1):262. DOI: 10.1186/s13054-016-1434-y.
  29. Weng H, Li J-G, Mao Z, Feng Y, Wang C-Y, Ren X-Q, et al. Probiotics for preventing ventilator-associated pneumonia in mechanically ventilated patients: a meta-analysis with trial sequential analysis. Front Pharmacol 2017;8:717. DOI: 10.3389/fphar.2017.00717.
  30. Whelan K, Myers CE. Safety of probiotics in patients receiving nutritional support: a systematic review of case reports, randomized controlled trials, and nonrandomized trials. Am J Clin Nutr 2010;91(3):687–703. DOI: 10.3945/ajcn.2009.28759.
  31. Didari T, Solki S, Mozaffari S, Nikfar S, Abdollahi M. A systematic review of the safety of probiotics. Expert Opin Drug Saf 2014;13(2):227–239. DOI: 10.1517/14740338.2014.872627.
  32. Cooke M, Ritmala-Castrén M, Dwan T, Mitchell M. Effectiveness of complementary and alternative medicine interventions for sleep quality in adult intensive care patients: a systematic review. Int J Nurs Stud 2020;107:103582. DOI: 10.1016/j.ijnurstu.2020.103582.
  33. Maia LP, Levi YLdAS, do Prado RL, dos Santos Santinoni C, Marsicano JA. Effects of probiotic therapy on serum inflammatory markers: a systematic review and meta-analysis. J Funct Foods 2019;54:466–478. DOI: 10.1016/J.JFF.2019.01.051.
  34. Sanaie S, Ebrahimi-Mameghani M, Hamishehkar H, Mojtahedzadeh M, Mahmoodpoor A. Effect of a multispecies probiotic on inflammatory markers in critically ill patients: a randomized, double-blind, placebo-controlled trial. J Res Med Sci 2014;19(9):827–833. PMID: 25535496.
  35. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. Journal of the American Medical Association 2009;302(21):2323–2329. DOI: 10.1001/jama.2009.1754.
  36. Timsit J-F, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res 2017;6:2061. DOI: 10.12688/f1000research.12222.1.
  37. Arthur LE, Kizor RS, Selim AG, van Driel ML, Seoane L. Antibiotics for ventilator-associated pneumonia. Cochrane Database Syst Rev 2016;10(10):Cd004267. DOI: 10.1002/14651858.CD004267.pub4.
  38. Branch-Elliman W, Wright SB, Howell MD. Determining the ideal strategy for ventilator-associated pneumonia prevention. Cost-benefit analysis. Am J Respir Crit Care Med 2015;192(1):57–63. DOI: 10.1164/rccm.201412-2316OC.
  39. Melsen WG, Rovers MM, Bonten MJ. Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009;37(10):2709–2718. DOI: 10.1097/ccm.0b013e3181ab8655.
  40. Doron S, Snydman DR. Risk and safety of probiotics. Clin Infect Dis 2015;60(suppl_2):S129–S134. DOI: 10.1093/cid/civ085.
  41. FDA. FDA developing improved methodology for determining purity of probiotic products. Available from: https://wwwfdagov/vaccines-blood-biologics/science-research-biologics/fda-developing-improved-methodology-determining-purity-probiotic-products. Content current as of: 05/10/2019.
  42. NIH. Probiotics: what you need to know. Available from: https://wwwnccihnihgov/health/probiotics-what-you-need-to-know. 2019.
  43. Hempel S, Newberry S, Ruelaz A, Wang Z, Miles JN, Suttorp MJ, et al. Safety of probiotics used to reduce risk and prevent or treat disease. Evid Rep Technol Assess (Full Rep) 2011(200):1–645. PMID: 23126627.
  44. Bafeta A, Koh M, Riveros C, Ravaud P. Harms reporting in randomized controlled trials of interventions aimed at modifying microbiota: a systematic review. Ann Intern Med 2018;169(4):240–247. DOI: 10.7326/M18-0343.
  45. Lherm T, Monet C, Nougière B, Soulier M, Larbi D, Le Gall C, et al. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med 2002;28(6):797–801. DOI: 10.1007/s00134-002-1267-9.
  46. Doron SI, Hibberd PL, Gorbach SL. Probiotics for prevention of antibiotic-associated diarrhea. J Clin Gastroenterol 2008;42:S58–S63. DOI: 10.1097/MCG.0b013e3181618ab7.
  47. Moggia E, Koti R, Belgaumkar AP, Fazio F, Pereira SP, Davidson BR, et al. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev 2017;4(4):CD011384. DOI: 10.1002/14651858.CD011384.pub2.
  48. Gu WJ, Deng T, Gong YZ, Jing R, Liu JC. The effects of probiotics in early enteral nutrition on the outcomes of trauma: a meta-analysis of randomized controlled trials. J Parenter Enteral Nutr 2013;37(3):310–317. DOI: 10.1177/0148607112463245.
  49. Litton E, Anstey M, Broadhurst D, Chapman AR, Currie A, Ferrier J, et al. Study protocol for the safety and efficacy of probiotic therapy on days alive and out of hospital in adult ICU patients: the multicentre, randomised, placebo-controlled Restoration Of gut microflora in Critical Illness Trial (ROCIT). BMJ Open 2020;10(6):e035930. DOI: 10.1136/bmjopen-2019-035930.
  50. Chen C, Wang J, Yin M, Zhao Q. Probiotics are effective in decreasing the incidence of ventilator-associated pneumonia in adult patients: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2018;11(10):10269–10277. Available from: https://e-century.us/files/ijcem/11/10/ijcem0071942.pdf
  51. Ego A, Preiser J-C, Vincent J-L. Impact of diagnostic criteria on the incidence of ventilator-associated pneumonia. Chest 2015;147(2):347–355. DOI: 10.1378/chest.14-0610.
  52. Wang J, Liu K-x, Ariani F, Tao L-l, Zhang J, Qu J-M. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-quality randomized controlled trials. PLoS One 2013;8(12):e83934. DOI: 10.1371/journal.pone.0083934.
  53. Liu K-x, Zhu Y-g, Zhang J, Tao L-l, Lee J-W, Wang X-d, et al. Probiotics’ effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and meta-analysis. Crit Care 2012;16(3):R109. DOI: 10.1186/cc11398.
  54. Watkinson PJ, Barber VS, Dark P, Young JD. The use of pre-pro-and synbiotics in adult intensive care unit patients: systematic review. Clin Nutr 2007;26(2):182–192. DOI: 10.1016/j.clnu.2006.07.010.
  55. Tan M, Zhu J-C, Du J, Zhang L-M, Yin H-H. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study. Crit Care 2011;15(6):R290. DOI: 10.1186/cc10579.
  56. Falcao de Arruda IS, de Aguilar-Nascimento JE. Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients. Clin Sci 2004;106(3):287–292. DOI: 10.1042/CS20030251.
  57. Brenner LA, Stearns-Yoder KA, Hoffberg AS, Penzenik ME, Starosta AJ, Hernandez TD, et al. Growing literature but limited evidence: a systematic review regarding prebiotic and probiotic interventions for those with traumatic brain injury and/or posttraumatic stress disorder. Brain Behav Immun 2017;65:57–67. DOI: 10.1016/j.bbi.2017. 06.003.
  58. Roquilly A, Marret E, Abraham E, Asehnoune K. Pneumonia prevention to decrease mortality in intensive care unit: a systematic review and meta-analysis. Clin Infect Dis 2015;60(1):64–75. DOI: 10.1093/cid/ciu740.
  59. van Ruissen MCE, Bos LD, Dickson RP, Dondorp AM, Schultsz C, Schultz MJ. Manipulation of the microbiome in critical illness-probiotics as a preventive measure against ventilator-associated pneumonia. Intensive Care Med Exp 2019;7(Suppl. 1):37. DOI: 10.1186/s40635-019-0238-1.
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