Intensive Care Medicine, 2009, Vol.35(5), pp.854-861
Byline: David J. W. Knight (1), Dale Gardiner (2), Amanda Banks (2), Susan E. Snape (3), Vivienne C. Weston (3), Stig Bengmark (4), Keith J. Girling (2,5) Keywords: Probiotics; Enteral nutrition; Nosocomial infections; Intensive care Abstract: Objective To investigate the effect of enteral Synbiotic 2000 FORTE.sup.(r) (a mixture of lactic acid bacteria and fibre) on the incidence of ventilator associated pneumonia (VAP) in critically ill patients. Design Prospective, randomised, double blind, placebo controlled trial. Setting Tertiary referral centre, general Adult Intensive Care Unit (ICU). Patients and participants 259 enterally fed patients requiring mechanical ventilation for 48 h or more were enrolled. Intervention All patients were enterally fed as per a standard protocol and randomly assigned to receive either synbiotic 2000 FORTE.sup.(r) (twice a day) or a cellulose-based placebo for a maximum of 28 days. Measurements and results Treatment group (n = 130) was well matched with placebo group (n = 129) for age (mean 49.5 and 50 years, respectively) and APACHE II score (median 17 for both). Oropharyngeal microbial flora and colonisation rates were unaffected by synbiotics. The overall incidence of VAP was lower than anticipated (11.2%) and no statistical difference was demonstrated between groups receiving synbiotic and placebo in the incidence of VAP (9 and 13%, P = 0.42), VAP rate per 1,000 ventilator days (13 and 14.6, P = 0.91) or hospital mortality (27 and 33%, P = 0.39), respectively. Conclusions Enteral administration of Synbiotic 2000 FORTE.sup.(r) has no statistically significant impact on the incidence of VAP in critically ill patients. Author Affiliation: (1) Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand (2) Department of Critical Care, Queen's Medical Centre, Nottingham, UK (3) Department of Microbiology, Queen's Medical Centre, Nottingham, UK (4) Department of Surgery, University College London, London, UK (5) Adult Intensive Care Unit, Queen's Medical Centre, Nottingham, NG7 2UH, UK Article History: Registration Date: 28/11/2008 Received Date: 10/12/2007 Accepted Date: 28/10/2008 Online Date: 16/12/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1368-1) contains supplementary material, which is available to authorized users.
Probiotics ; Enteral nutrition ; Nosocomial infections ; Intensive care
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