Title : The new barriers to using Synbiotic and probiotic supplementations in hospitalized critically ill patients
Abstract:
Introduction: Critical ill patients, regardless of the effect and variety of diseases, are at higher risk of losing “health-promoting” gut microbiota as well as overgrowth of pathogenic bacteria. This condition can lead the critically ill patients to higher infections and inflammation, sepsis, multi-organ failure (MOF), muscle wasting, and cachexia. Currently, synbiotics and probiotics are considered immunomodulatory agents that can be considered effective supplements for patients.
Method: This study reviewed current findings and recent unpublished evidence of the impact of synbiotics and probiotics in critically ill patients.
Result: In practice, the results of clinical studies are heterogeneous which prevents giving a firm answer to the impact of synbiotics and probiotics on critical illness. However, the literature regarding the impact of symbiotics and probiotics in critically ill patients is still in the exploring phase. The findings show no harmful impact of using probiotics and synbiotics in critical illness. In theory, gut microbiota modulation using synbiotics and probiotics can be considered an effective method to control pathogenic bacteria to reduce the infection. In addition, these supplements have the potential to improve energy and macronutrient homeostasis, reduce muscle wasting and improve clinical outcomes. Despite the exact mechanism being still unclear, there is evidence that these improvements result from maintaining and nourishing gut epithelial barrier and cells as well as replacing the host metabolism, and enhancing immune function. Nevertheless, there are evidences that the energy balance of these supplements has no significant beneficial impact on feeding tolerance and energy homeostasis. However, it significantly controls the prevalence and duration of diarrhea in critically ill patients. The limited data on critical illness suggests fasting blood glucose (FBG), insulin, and lipid profile do not significantly change by synbiotic and probiotic. There are also reports that nitrogen balance (clinically) and inflammatory markers significantly improve. So, despite the use of synbiotics and probiotics can have no effect on biochemical factors, it may have the potential to reduce the systemic inflammatory, sepsis, wasting and MOF that are the important concerns in critical care. Although clinical endpoints such as ICU length of stay and mortality rate remain unchanged. The works on this subject are limited and heterogeneous which required research more.
Conclusion: Studies suggest probiotics and synbiotics are safe in critical care and probiotic administration has beneficial effects that could be considered an adjunct therapy for critically ill patients. However, still more work is required.
Keywords: ICU, critically ill, Probiotic, Synbiotic
