乳杆菌疗法对重症成人患者机械通气疗法持续时间的影响

　　益生菌是维持肠道微生态平衡的重要因素，乳杆菌就是其中重要的一类。美国密苏里州考克斯医院通过一项前瞻研究观察益生菌对于重症患者预后的影响。

　　该研究入组140例接受肠内营养（EN）的重症患者，随机分成两组：乳杆菌添加组、对照组。

　　结果发现，两组机械通气时间（P=0.6）、ICU入住时间（P=0.15）、总住院时间（P=0.41）均无统计学差异。

JPEN J Parenter Enteral Nutr. 2017;41(2):283-284.

Evaluation of lactobacillus therapy on duration of mechanical ventilation therapy in critically ill adult patients.

Divya M. Daniel, Karrie Derenski, Jennifer Catlin.

Pharmacy, CoxHealth, Springfield, Missouri, USA.

PURPOSE: The objective of this study is to evaluate the effect(s) of the probiotic Lactobacillus rhamnosus GG (LGG) (eg, ventilator-free days, length of stay [LOS], and mortality in intensive care units) when administered to ventilated critically ill patients receiving enteral nutrition (EN) in a community hospital.

METHODS: This is a minimal-risk, prospective, observational study meant to examine approximately 140 patients partitioned into 2 groups of critically ill patients receiving EN therapy: group 1 (control group) and group 2 (recipients of probiotic therapy). Group 2 patients will receive LGG via capsules from a commercially available product on hospital formulary. Inclusion criteria were (1) patients ≥18 years old, (2) mechanical ventilation initiated within 48 hours of intensive care unit (ICU) admission, and (3) patient is anticipated to receive EN therapy for at least 48 hours. Exclusion criteria include (1) inability to be fed through the gastrointestinal tract; (2) contraindication to LGG or any of the ingredients found in Culturelle; (3) known or reported history of infection with LGG or other probiotic; (4) concurrent or anticipated therapy with mannitol or lactulose; (5) short gut syndrome; (6) previous bone marrow, liver, lung, or kidney transplant; and (7) patient not anticipated to survive past 7 days.

RESULTS: A Student t test (P value set at 5%) was used to calculate statistics for primary outcome of time on mechanical ventilation (TMV), as well as secondary outcomes, including ICU and hospital LOS. No statistically significant difference was seen in either the primary or secondary outcomes. A total of 2040 patients were screened, and of those, 140 patients were included in the study. Primary outcome of TMV was not statistically significant between the 2 groups. The average TMV was 7.7 days for the control group and 7 days for the probiotic group (P = .6; 95% confidence interval [CI], -0.7305 to 2.0905). Secondary outcomes, including ICU and hospital LOS, were also not statistically different between the 2 groups. The average ICU and hospital LOS were 10.8 days and 16.04 days for the control group and 9.75 days and 15.27 days for the probiotic group (P = .15; 95% CI, -0.39 to 2.49). Mortality was similar between the 2 groups at 20% in the control group and 21% in the probiotic group (P = .85%). Adequacy of total calories from nutrition support was achieved for 54.1% ICU days in the control group and 70.2% in the probiotic group.

CONCLUSIONS: There was no statistically significant or clinical difference between the outcomes (eg, duration of mechanical ventilation, ICU and/or hospital LOS, 28-day mortality) between the test group, receiving LGG supplementation, and the control group. Strengths of this study include both the review of general ICU patients, with various admission types in both groups (test and control), and the high acuity of patient illness. Weaknesses of this study include the wide ranges of confidence intervals, small sample populations (despite meeting power), and the observational nature of this study. While no differences in patient outcomes were observed, a continuation of this research, applying identical protocols to a larger population, should be performed to definitively comment on the efficacy of probiotic therapy.

DOI: 10.1177/0148607116686023