Abstract
Background and Objective: Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients.Methods: PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs) comparing probiotics with control in mechanically ventilated patients were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated with fixed or random effects models. Trial sequential analysis (TSA) was performed using TSA 0.9beta software.Results: Thirteen RCTs (N = 1969) were included. Overall, probiotics were associated with reduced incidence of VAP (RR = 0.73, 95% CI = 0.60–0.89; P = 0.002), which was confirmed by TSA (TSA adjusted 95% CI = 0.55–0.96). However, no significant difference was observed in 90-day mortality (RR = 1.00, 95% CI = 0.72–1.37; P = 0.99), overall mortality (RR = 0.84, 95% CI = 0.70–1.02; P = 0.09), 28-day mortality (RR = 1.06, 95% CI = 0.72–1.57; P = 0.99), intensive care unit (ICU) mortality (RR = 0.97, 95% CI = 0.74–1.27; P = 0.82), hospital mortality (RR = 0.81, 95% CI = 0.65–1.02; P = 0.07), diarrhea (RR = 0.99, 95% CI = 0.83–1.19; P = 0.92), length of ICU stay (MD = −2.40 days, 95% CI = −6.75 to 1.95; P = 0.28), length of hospital stay (MD = −1.34 days, 95% CI = −6.21 to 3.54; P = 0.59), and duration of mechanical ventilation (MD = −3.32 days, 95% CI = −6.74 to 0.09; P = 0.06).Conclusions: In this meta-analysis, we found that probiotics could reduce the incidence of VAP in mechanically ventilated patients. It seems likely that probiotics provide clinical benefits for mechanically ventilated patients.
Highlights
Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients even though the incidence thereof has been decreased in the past several years in America (Metersky et al, 2016)
The inclusion criteria were a s following: (1) patients: the study subjects were mechanically ventilated patients; (2) intervention: probiotics; (3) comparison: placebo or other drugs; (4) outcomes: primary outcome was incidence of VAP; secondary outcomes were 90-day mortality, overall mortality, 28-day mortality, intensive care unit (ICU) mortality, and hospital mortality; tertiary outcomes were diarrhea, length of ICU stay, length of hospital stay, and duration of mechanical ventilation; (5) study type: only randomized controlled trials (RCTs) that were peer-reviewed and available in full-text would be included in this metaanalysis
After strict screening according to inclusion criteria, 13 RCTs (Spindler-Vesel et al, 2007; Forestier et al, 2008; Klarin et al, 2008; Giamarellos-Bourboulis et al, 2009; Knight et al, 2009; Barraud et al, 2010; Morrow et al, 2010; Oudhuis et al, 2011; Tan et al, 2011; Li et al, 2012; Banupriya et al, 2015; Rongrungruang et al, 2015; Zeng et al, 2016) were included in the present meta-analysis
Summary
Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients even though the incidence thereof has been decreased in the past several years in America (Metersky et al, 2016). A simple, inexpensive, and safe prevention strategy will contribute to the decrease of VAP occurrence rate and corresponding burden. Numerous studies have assessed various strategies of VAP prevention which can be classified into pharmacologic and non-pharmacologic interventions. Probiotics have been considered as a new intervention for VAP prevention in critical care medicine. Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients
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