Clinical Benefits From Administering Probiotics to Mechanical Ventilated Patients in Intensive Care Unit: A PRISMA-Guided Meta-Analysis

Background: The use of probiotics has been considered as a new intervention for ventilator-associated pneumonia (VAP) prevention in the intensive care unit (ICU). The aim of this meta-analysis was to evaluate the effect of probiotics on mechanical-ventilated patients in ICU.Methods: PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) from their respective inception through October 10, 2021. All studies meeting the inclusion criteria were selected to evaluate the effect of probiotics on patients receiving mechanical ventilation in ICU.Results: A total of 15 studies involving 4,693 participants met our inclusion criterion and were included in this meta-analysis. The incidence of VAP in the probiotic group was significantly lower (odds ratio [OR] 0.58, 95% CI 0.41 to 0.81; p = 0.002; I-2 = 71%). However, a publication bias may be present as the test of asymmetry was significant (p = 0.007). The probiotic administration was associated with a significant reduction in the duration of mechanical ventilation (mean difference [MD] -1.57, 95% CI -3.12 to -0.03; p = 0.05; inconsistency [I](2) = 80%), length of ICU stay (MD -1.87, 95% CI -3.45 to -0.28; p = 0.02; I-2 = 76%), and incidence of bacterial colonization (OR 0.59, 95% CI 0.45 to 0.78; p = 0.0001; I-2 = 34%). Moreover, no statistically significant differences were observed regarding the incidence of diarrhea (OR 0.90, 95% CI 0.65 to 1.25; p = 0.54; I-2 = 12%) and mortality (OR 0.91, 95% CI 0.80 to 1.05; p = 0.19; I-2 = 0%) between probiotics group and control group.Conclusion: Our meta-analysis shows that probiotics are associated with a reduction in VAP, as well as the duration of mechanical ventilation, ICU length of stay, and bacterial colonization, but no significant effects on ICU mortality and occurrence of diarrhea. However, in consideration of the significant heterogeneity and publication bias, our findings need to be further validated.

Automated summary

This meta-analysis suggests that probiotics are effective in reducing the occurrence of ventilator-associated pneumonia (VAP), as well as shortening the duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and incidence of bacterial colonization. However, there is no significant effect on ICU mortality and occurrence of diarrhea. Further validation is needed due to the significant heterogeneity and publication bias.