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

医学 随机对照试验 荟萃分析 相对风险 内科学 机械通风 安慰剂 肺炎 合生元 梅德林 呼吸机相关性肺炎 置信区间 重症监护医学 替代医学 益生菌 病理 生物 细菌 政治学 法学 遗传学
作者
Sameer Sharif,Alisha Greer,Clarissa Skorupski,Qiukui Hao,Jennie Johnstone,Joanna C. Dionne,Vincent I. Lau,William Manzanares,Mohamed Eltorki,Erick Duan,François Lauzier,John C. Marshall,Diane Heels‐Ansdell,Lehana Thabane,Deborah J. Cook,Bram Rochwerg
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:50 (8): 1175-1186 被引量:43
标识
DOI:10.1097/ccm.0000000000005580
摘要

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 DATA SOURCES: We searched MEDLINE, EMBASE, CENTRAL, and unpublished sources from inception to May 4, 2021.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