Advertisement

World Journal of Surgery

, Volume 30, Issue 10, pp 1848–1855 | Cite as

Benefits of a Synbiotic Formula (Synbiotic 2000Forte®) in Critically Ill Trauma Patients: Early Results of a Randomized Controlled Trial

  • Katerina Kotzampassi
  • Evagellos J. Giamarellos-Bourboulis
  • Antonios Voudouris
  • Pantelis Kazamias
  • Efthimios Eleftheriadis
Article

Abstract

Background

Since probiotics are considered to exert beneficial health effects by enhancing the host’s immune response, we investigated the benefits of a synbiotics treatment on the rate of infections, systemic inflammatory response syndrome (SIRS), severe sepsis, and mortality in critically ill, mechanically ventilated, multiple trauma patients. Length of stay in the intensive care unit (ICU) and number of days under mechanical ventilation were also evaluated.

Method

Sixty-five patients were randomized to receive once daily for 15 days a synbiotic formula (Synbiotic 2000Forte, Medipharm, Sweden) or maltodextrin as placebo. The synbiotic preparation consisted of a combination of four probiotics (1011 CFU each): Pediococcus pentosaceus 5–33:3, Leuconostoc mesenteroides 32–77:1, L. paracasei ssp. paracasei 19; and L. plantarum 2,362; and inulin, oat bran, pectin, and resistant starch as prebiotics. Infections, septic complications, mortality, days under ventilatory support, and days of stay in ICU were recorded.

Results

Synbiotic-treated patients exhibited a significantly reduced rate of infections (P = 0.01), SIRS, severe sepsis (P = 0.02), and mortality. Days of stay in the ICU (P = 0.01) and days under mechanical ventilation were also significantly reduced in relation to placebo (P = 0.001).

Conclusion

The administration of this synbiotic formula in critically ill, mechanically ventilated, multiple trauma patients seems to exert beneficial effects in respect to infection and sepsis rates and to improve the patient’s response, thus reducing the duration of ventilatory support and intensive care treatment.

Keywords

Intensive Care Unit Severe Sepsis Systemic Inflammatory Response Syndrome Intensive Care Unit Stay Resistant Starch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Deitch EA. Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 1992;216:117–134PubMedGoogle Scholar
  2. 2.
    Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive Care [EPIC] study. EPIC International Advisory Committee. J Am Med Assoc 1995;274:639–644CrossRefGoogle Scholar
  3. 3.
    Marshall JC. Gastrointestinal flora and its alterations in critical illness. Curr Opin Clin Nutr Metabc Care 1999;2:405–411CrossRefGoogle Scholar
  4. 4.
    Isolauri E, Salminen S, Ouwehand AC. Microbial-gut interactions in health and disease. Probiotics. Best Pract Res Clin Gastroenterol 2004;18:299–313PubMedCrossRefGoogle Scholar
  5. 5.
    Bengmark S. Econutrition and health maintenance—a new concept to prevent GI inflammation, ulceration and sepsis. Clin Nutr 1996;15:1–10PubMedCrossRefGoogle Scholar
  6. 6.
    Kailasapathy K, Chin J. Survival and therapeutic potential of probiotic organisms with reference to Lactobacillus acidophilus and Bifidobacterium spp. Immunol Cell Biol 2000;78:80–88PubMedCrossRefGoogle Scholar
  7. 7.
    McNaught CE, Woodcock NP, MacFie J, et al. A prospective randomised study of the probiotic Lactobacillus plantarum 299 V on indices of gut barrier function in elective surgical patients. Gut 2002;51:827–831PubMedCrossRefGoogle Scholar
  8. 8.
    Pittet D, Thievent B, Wenzel RP, et al. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 1993;19:265–272PubMedCrossRefGoogle Scholar
  9. 9.
    Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829PubMedGoogle Scholar
  10. 10.
    Knaus WA, Draper EA, Wagner DP, et al. Prognosis in acute organ-system failure. Ann Surg 1985;202:685–693PubMedGoogle Scholar
  11. 11.
    Pittet D, Thievent B, Wenzel RP, et al. Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Amer Jl Resp Crit Care Med 1996;153:684–693Google Scholar
  12. 12.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and multiple organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–874Google Scholar
  13. 13.
    Bone RC, Balk RA, Cerra FB, et al. The ACCP/SCCM Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1656–1662Google Scholar
  14. 14.
    Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med 2000;26:S64–S74PubMedCrossRefGoogle Scholar
  15. 15.
    Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140PubMedCrossRefGoogle Scholar
  16. 16.
    Chastre J, Fagon JY. Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia. Am J Respir Crit Care Med 1994;150:570–574PubMedGoogle Scholar
  17. 17.
    American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement. Am J Respir Crit Care Med 1996;153:1711–1725Google Scholar
  18. 18.
    Eggimann P, Pittet D. Infection control in the ICU. Chest 2001;120:2059–2093PubMedCrossRefGoogle Scholar
  19. 19.
    Brunkhorst FM, Wegscheider K, Forycki ZF, et al. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 2000;26 [Suppl 2]: S148–S152CrossRefGoogle Scholar
  20. 20.
    Zahorec R. Definition for septic syndrome should be re-evaluated. Intensive Care Med 2000;26:1870PubMedCrossRefGoogle Scholar
  21. 21.
    Giamarellos-Bourboulis EJ, Plachouras D, Tzivra A, et al. Stimulation of innate immunity by susceptible and multidrug-resistant Pseudomonas aeruginosa: an in vitro and in vivo study. Clin Experimental Immunol 2004;135:240–246CrossRefGoogle Scholar
  22. 22.
    Alverdy J, Zaborina O, Wu L. The impact of stress and nutrition on bacterial-host interactions at the intestinal epithelial surface. Curr Opin in Clin Nutr Metab Care 2005;8:205–209CrossRefGoogle Scholar
  23. 23.
    Bengmark S. Synbiotics to strengthen gut barrier function and reduce morbidity in critically ill patients. Clin Nutr 2004;23:441–445PubMedCrossRefGoogle Scholar
  24. 24.
    Knight DJW, Girling KJ. Gut flora in health and disease. Lancet 2003;361:1831PubMedCrossRefGoogle Scholar
  25. 25.
    Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, et al. Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell 2004;118:229–241PubMedCrossRefGoogle Scholar
  26. 26.
    Gomersall CM. Does the Administration of Lactobacillus to Critically Ill Patients Decrease the Severity of Multi-Organ Dysfunction and Failure? A Pilot Study. London, Roehampton Institute, School of Life Sciences, 1998Google Scholar
  27. 27.
    Bengmark S, Martindale R. Prebiotics and synbiotics in clinical medicine. Nutr in Clin Pract 2005;20:244–261Google Scholar
  28. 28.
    Olah A, Belagyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg 2002;89:1103–1107PubMedCrossRefGoogle Scholar
  29. 29.
    Duncan C, Dougall H, Johnston P, et al. Chemical generation of nitric oxide in the mouth from the enterosalivary circulation of dietary nitrate. Nat Med 1995;1:546–551PubMedCrossRefGoogle Scholar
  30. 30.
    Bengmark S. Ecological control of the gastrointestinal tract. The role of probiotic flora. Gut 1998;42:2–7PubMedCrossRefGoogle Scholar
  31. 31.
    Wright CE, Rees DD, Moncada S. Protective and pathological role of nitric oxide in endotoxin shock. Cardiovasc Res 1992;26:48–57PubMedCrossRefGoogle Scholar
  32. 32.
    Cremonini F, Di Caro S, Nista EC, et al. Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2002;16:1461–1467PubMedCrossRefGoogle Scholar
  33. 33.
    D’Souza AL, Rajkumar C, Cooke J, et al. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. Br Med J 2002;324:1361CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Katerina Kotzampassi
    • 1
  • Evagellos J. Giamarellos-Bourboulis
    • 2
  • Antonios Voudouris
    • 1
  • Pantelis Kazamias
    • 3
  • Efthimios Eleftheriadis
    • 1
  1. 1.Department of Surgery, Faculty of MedicineUniversity of ThessalonikiThessalonikiGreece
  2. 2.Department of Internal Medicine, Faculty of MedicineUniversity of AthensAthensGreece
  3. 3.ICU of 424th Military HospitalThessalonikiGreece

Personalised recommendations