Blackmores Institute

As an infectious inflammatory reaction of the lung parenchyma, ventilator-associated pneumonia (VAP), occurs after mechanical ventilation for more than 48 hours and can lead to a prolonged hospital stay, increased medical costs and a higher mortality risk.
 
 Reviewing 14 studies involving 1975 subjects, the results found probiotic administration was associated with a reduction in VAP incidence among all 13 studies included in the meta-analysis (Odd ratio (O)R 0.62, 95% confidence interval (CI) 0.45–0.85; P 5 .003; I2 5 43%) but not among the six double-blinded studies (OR 0.72, 95% CI 0.44–1.19; P 5 .20; I2 5 55%).
 
 “We searched a number of medical literature databases to identify randomised controlled trials that compared probiotics with controls for VAP prevention. We found a shorter duration of antibiotic use for VAP (mean difference 21.44, 95% CI 22.88 to 20.01; P 5 .048, I2 5 30%) in the probiotics group than in the control group.”
 
 “Our meta-analysis demonstrated that probiotics significantly decreased the incidence of VAP.”
 
 “However, no appreciable effects were conferred by probiotics on intensive care unit (ICU) mortality, length of ICU stay, duration of mechanical ventilation, or occurrence of diarrhoea,” the authors reported.
 
 The review found no adverse effects related to probiotics were observed in the included studies and that analysis of a substantial number of findings suggested that probiotics were a promising option for VAP prevention.
 
 “For instance, probiotics stimulate immune responses by increasing phagocytic cell function and inducing the release of cytokines (interleukin [IL] 1, IL-2, IL-6, IL-12, IL-18, tumour necrosis factor alpha, interferon gamma) and regulate the local inflammatory response by up-regulating transforming growth factor beta and IL-10.
 
 “In addition Lactobacillus promotes mucin secretion, forms a mucus barrier, and blocks the invasion and adhesion of pathogenic bacteria and probiotics synthesis short-chain fatty acids, reduce intestinal pH and inhibit the colonisation of acid-resistant pathogens, for example,” the authors said.
 
 Due to these features, the authors suggest that for VAP prevention, the specific probiotic strains, patient population, optimal dosage and proper administration must be considered in further research.
 
 “An analysis of the available evidence demonstrated that probiotics can reduce the incidence of VAP. Further large- scale, well-designed clinical trials are required to validate this effect and to determine the optimum probiotic strains for the prevention of VAP,” the authors concluded.
 
 
 Source:
 Respiratory Care. 2020. DOI: <a href="https://doi.org/10.4187/respcare.07097">10.4187/respcare.07097</a>

Ventilator-associated pneumonia, a common and serious complication of mechanical ventilation, may be reduced by the administration of probiotics according to a recently published meta-analysis.

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