Effect of gut microbiota modulation on feeding tolerance of enterally fed critically ill adult patients: a systematic review

Najmeh Seifi,Mohsen Nematy,Ali Jafarzadeh Esfahani,Mohammad Safarian,Majid Khadem-Rezaiyan,Reza Rezvani,Alireza Sedaghat

doi:10.1186/s13643-021-01633-5

Najmeh Seifi, Mohsen Nematy + Show 5 more

Open Access

https://doi.org/10.1186/s13643-021-01633-5

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Journal: Systematic Reviews	Publication Date: Apr 2, 2021
Citations: 8	License type: open-access

Affiliation: Mashhad University of Medical Sciences

Abstract

PurposeThe objective of this systematic review was to evaluate the effect of pre-, pro-, and synbiotics on feeding tolerance of enterally fed critically ill adult patients.MethodsMEDLINE, Science Direct, Web of Knowledge, and the Cochrane Central Register of Controlled Trials were searched up to November 2019. English language randomized controlled trials reporting the effect of pre, pro or synbiotics on the feeding tolerance of enterally fed critically ill adult patients were included.ResultsOverall, 15 papers were selected for review. Among six studies reporting the energy intake, only two studies showed significantly higher energy intake in the prebiotic-receiving groups. Among four RCTs reporting frequency or time to achieve the target calorie, only one found a significant effect of probiotics to reduce the time to achieve a target dose of calorie. About the prevalence or duration of diarrhea, 7 out of 12 RCTs reported a beneficial effect. All but one study found no beneficial effects for gut microbiota manipulation on clinical endpoints including length of stay (LOS) in hospital and intensive care unit (ICU).ConclusionIt should be noticed that the heterogeneity in study designs, product format, and ICU patient populations makes it difficult to draw any general conclusion. Overall, it seems that pre, pro, or synbiotics have no significant beneficial effect on feeding tolerance and clinical endpoints in critically ill adults, but they may reduce the prevalence or duration of diarrhea.

Highlights

Critical illness can cause hypermetabolism and hypercatabolic state that quickly depletes nutritional reserves, alters immune function, and predisposes individuals to morbidities and mortality [1, 2]
Factors associated with feeding intolerance in critically ill patients include stress-induced hyperglycemia; hormonal disturbances (including high levels of cholecystokinin (CCK), and peptide YY (PYY), and low levels of motilin); administration of sedatives, analgesics, and vasopressor agents; and disturbances in gut microbiota
Overall, the heterogeneity in studied product format, intensive care unit (ICU) patient populations, and study designs make it difficult to draw any general conclusion on the effect of pre, pro, or synbiotics on feeding tolerance of critically ill tube-fed patients

Summary

Introduction

Critical illness can cause hypermetabolism and hypercatabolic state that quickly depletes nutritional reserves, alters immune function, and predisposes individuals to morbidities and mortality [1, 2]. Ill patients are likely to experience severe changes in gut function. These changes are due to alterations in gut muscle. Factors associated with feeding intolerance in critically ill patients include stress-induced hyperglycemia; hormonal disturbances (including high levels of cholecystokinin (CCK), and peptide YY (PYY), and low levels of motilin); administration of sedatives, analgesics, and vasopressor agents; and disturbances in gut microbiota. These factors result in gastrointestinal dysfunction and manifest as feeding intolerance [9]

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