Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,Critical Care Medicine

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Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Critical Care Medicine ( IF 8.8 ) Pub Date : 2022-05-25 , DOI: 10.1097/ccm.0000000000005580
Sameer Sharif _{1,

2} , Alisha Greer _{1,

2} , Clarissa Skorupski ₃ , Qiukui Hao _{4,

5} , Jennie Johnstone _{6,

7} , Joanna C Dionne _{2,

8} , Vincent Lau ₉ , William Manzanares ₁₀ , Mohamed Eltorki ₁₁ , Erick Duan ₂ , Francois Lauzier _{12,

13} , John C Marshall _{14,

15} , Diane Heels-Ansdell ₈ , Lehana Thabane ₈ , Deborah J Cook _{2,

8} , Bram Rochwerg _{2,

8}

Affiliation

Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Faculty of Health Sciences, McMaster University, Hamilton ON, Canada.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, AB, Canada.
Department of Critical Care, Hospital de Clínicas, Faculty of Medicine, UdelaR, Montevideo, Uruguay.
Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Department of Medicine, Université Laval, Quebec City, QC, Canada.
Population Health and Optimal Health Practice Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Centre, Quebec City, QC, Canada.
Department of Surgery, Unity Health Toronto/University of Toronto, Toronto, ON, Canada.
Department of Critical Care Medicine, Unity Health Toronto/University of Toronto, Toronto, ON, Canada.

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We searched MEDLINE, EMBASE, CENTRAL, and unpublished sources from inception to May 4, 2021.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.

中文翻译：

益生菌在危重疾病中的应用：随机对照试验的系统回顾和荟萃分析

目标：

确定益生菌或合生元对危重成人和儿童发病率和死亡率的安全性和有效性。

数据源：

我们检索了从开始到 2021 年 5 月 4 日的 MEDLINE、EMBASE、CENTRAL 和未发表的来源。

研究选择：

我们对危重患者中肠内益生菌或合生元与安慰剂或不治疗进行比较的随机对照试验 (RCT) 进行了系统搜索。我们独立地一式两份地筛选研究。

数据提取：

独立评审员重复提取数据。使用随机效应模型来汇集数据。我们使用分级建议评估、制定和评估方法评估了每个结果的证据的总体确定性。

数据综合：

65 项 RCT 纳入了 8,483 名患者。益生菌可以减少呼吸机相关性肺炎 (VAP)（相对风险 [RR]，0.72；95% CI，0.59 至 0.89，风险差 [RD]，降低 6.9%；95% CI，降低 2.7-10.2%；低确定性）、医疗保健相关肺炎 (HAP)（RR，0.70；95% CI，0.55–0.89；RD，减少 5.5%；95% CI，减少 8.2–2.0%；低确定性）、ICU 住院时间 (LOS)（平均差异 [MD]，减少 1.38 天；95% CI，减少 0.57–2.19 天；低确定性）、医院 LOS（MD，减少 2.21 天；95% CI，减少 1.18–3.24 天；低确定性）以及侵入性持续时间机械通气（MD，减少 2.53 天；95% CI，减少 1.31–3.74 天；低确定性）。益生菌可能对死亡率没有影响（RR，0.95；95% CI，0.87-1.04；RD，降低 1.1%；95% CI，降低 2.8% 至增加 0.8%；中等确定性）。没有高风险偏倚研究的事后敏感性分析否定了益生菌对 VAP、HAP 和医院 LOS 的影响。