Probiotics in the Intensive Care Unit

Abstract

The understanding of the gut microbiome in health and disease has shown tremendous progress in the last decade. Shaped and balanced throughout life, the gut microbiome is intricately related to the local and systemic immune system and a multitude of mechanisms through which the gut microbiome contributes to the host’s defense against pathogens have been revealed. Similarly, a plethora of negative consequences, such as superinfections and an increased rate of hospital re-admissions, have been identified when the gut microbiome is disturbed by disease or by the iatrogenic effects of antibiotic treatment and other interventions. In this review, we describe the role that probiotics may play in the intensive care unit (ICU). We discuss what is known about the gut microbiome of the critically ill, and the concept of probiotic intervention to positively modulate the gut microbiome. We summarize the evidence derived from randomized clinical trials in this context, with a focus on the prevention of ventilator-associated pneumonia. Finally, we consider what lessons we can learn in terms of the current challenges, efficacy and safety of probiotics in the ICU and what we may expect from the future. Throughout the review, we highlight studies that have provided conceptual advances to the field or have revealed a specific mechanism; this narrative review is not intended as a comprehensive summary of the literature.

Hypercatabolism and Anti-catabolic Therapies in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome

“…The application of microbial modulators, such as probiotics, aims to restore intestinal microbiota balance and intestinal homeostasis in critically ill patients. Microbiota regulators have two main uses; one is to increase the number of beneficial bacteria and the other is to reduce the number of disease-causing bacteria ( 101 ). Probiotics, most commonly Lactobacillus and Bifidobacterium , inhibit the growth of pathogenic bacteria and prevent gut bacteria from migrating to the blood and other organs to rebuild the damaged gut microbiome and restore normal gut function ( 102 ).…”

Critical illness and bone metabolism: where are we now and what is next?

“…Administration of prebiotics leads to enhanced calcium absorption and favorable changes in gut microbiota composition, resulting in improved bone mass [ 67 ]. In addition, a variety of endogenous and iatrogenic factors, such as gastrointestinal motility disorders, changes in intraluminal pH, increased catecholamine production, antibiotic therapy, proton pump inhibitors, opioids, and enteral feeding, can contribute to the development of severe disruption of the microbiota in CIPs [ 68 ]. Thus, microbiome modulation may become a novel adjuvant for the prevention and even treatment of ICU-related osteoporosis or osteoporosis.…”

Pathophysiology and Therapeutic Management of Bone Loss in Patients with Critical Illness

“…Experimental data have shown that modulation of gut microbiota with probiotics administration can increase bone mass [102]. Pharmacological therapy using prebiotics leads to enhanced calcium absorption and favorable changes in gut microbiota composition, resulting in improved bone mass [103,104]. Moreover, numerous endogenous and iatrogenic factors, such as gastrointestinal disorders, administration of antibiotics, proton pump inhibitors, and opioids, along with enteral feeding, can further influence the progressive disruption of the gut microbiota in the ICU population [104].…”