Intensive Care Medicine

, Volume 36, Issue 9, pp 1540–1547 | Cite as

Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial

  • Damien Barraud
  • Claire Blard
  • François Hein
  • Olivier Marçon
  • Aurélie Cravoisy
  • Lionel Nace
  • François Alla
  • Pierre-Edouard Bollaert
  • Sébastien Gibot
Original

Abstract

Purpose

Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days.

Methods

This study was performed as a double-blind, concealed randomized, placebo-controlled trial in a French medical intensive care unit (ICU). Adult patients mechanically ventilated for a period of more than 48 h received enterally administered probiotics (Ergyphilus ®, 2 × 1010 lactic acid bacteria, mostly Lactobacillus rhamnosus GG, once a day) or placebo until successful weaning.

Results

A total of 167 patients were included. The two groups were comparable at baseline. The 28-day mortality rates were not different in the probiotic (25.3%) and placebo groups (23.7%). Mortality rates in ICU and at 90 days were also unaffected by the treatment. The incidence of ICU-acquired infections did not differ significantly except for that of catheter-related bloodstream infections that was lowered by probiotics. On a prespecified subgroup analysis, we found a reduction of the 28-day mortality among severe sepsis patients (total n = 101) treated with probiotics (n = 52) with an odds ratio (OR) for death at 0.38 (95% CI 0.16–0.93, p = 0.035). By contrast, probiotics were associated with a higher mortality rate in non-severe sepsis patients (OR 3.09, 95% CI 0.87–11.01, p = 0.08).

Conclusions

Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.

Keywords

Mechanical ventilation ICU-acquired infections Probiotics 

Notes

Acknowledgment

This work was financially funded by CHU Nancy.

Conflict of interest

None of the authors declare any conflict of interest in relation to this study.

Supplementary material

134_2010_1927_MOESM1_ESM.docx (27 kb)
Supplementary material (DOCX 26 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Damien Barraud
    • 1
    • 2
  • Claire Blard
    • 3
  • François Hein
    • 1
    • 2
  • Olivier Marçon
    • 1
    • 2
  • Aurélie Cravoisy
    • 1
    • 2
  • Lionel Nace
    • 1
    • 2
  • François Alla
    • 4
  • Pierre-Edouard Bollaert
    • 1
    • 2
  • Sébastien Gibot
    • 1
    • 2
  1. 1.Service de Réanimation Médicale, Hôpital CentralCHU NancyNancy CedexFrance
  2. 2.Centre d’Investigations Cliniques-INSERM 9501, CHU de NancyNancyFrance
  3. 3.Service de Réanimation polyvalenteCHG MâconMâconFrance
  4. 4.Service d’épidémiologie et d’évaluation cliniquesCHU NancyNancyFrance

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