The use of pre- pro- and synbiotics in adult intensive care unit patients: Systematic review

Background & Aims: This review investigated whether the administration of enteral pre-, pro- and synbiotics compared with controls in adult intensive care unit (ICU) patients reduced the incidence of nosocomial infections, length of ICU stay, hospital mortality and specifically pneumonia. Methods: Systematic review of randomised controlled trials comparing enteral feeding and pre-, pro- or synbiotics, versus standard enteral feed alone, in patients admitted to adult ICUs. Results: Eight randomised studies with a total of 999 critically ill adult patients met the inclusion criteria. Pre- pro- or synbiotics were not associated with any significant change in the outcomes studied-length of ICU stay, hospital mortality and the incidence of nosocomial infection and more specifically pneumonia incidence. Few data were available for other outcomes. Conclusions: The use of pre- pro- or synbiotics in adult critically ill patients confers no statistically significant benefit in the outcome criteria studied. There is currently a lack of evidence to support the use of pre- pro- or synbiotics in patients admitted to adult ICUs, and a large well-designed trial is needed in this area. (c) 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.