Mustansir Dawoodbhoy Fatema, Patel Bharati Kadamb, Patel Kadamb, Bhatia Madhav, Lee Chuen Neng, Moochhala Shabbir M
Department of Medicine, Imperial College London, London, UK.
Department of Surgery, National University of Singapore, Singapore.
Shock. 2021 Apr 1;55(4):441-454. doi: 10.1097/SHK.0000000000001654.
Critical illness results in significant changes in the human gut microbiota, leading to the breakdown of the intestinal barrier function, which plays a role in the pathogenesis of multiple organ dysfunction. Patients with sepsis/acute respiratory distress syndrome (ARDS) have a profoundly distorted intestinal microbiota rhythm, which plays a considerable role in the development of gut-derived infections and intestinal dysbiosis. Despite recent medical developments, postsurgical complications are associated with a high morbidity and mortality rate. Bacterial translocation, which is the movement of bacteria and bacterial products across the intestinal barrier, was shown to be a mechanism behind sepsis. Current research is focusing on a solution by addressing significant factors that contribute to intestinal dysbiosis, which subsequently leads to multiple organ failure and, thus, mortality. It may, however, be challenging to manipulate the microbiota in critically ill patients for enhanced therapeutic gain. Probiotic manipulation is advantageous for maintaining the gut-barrier defense and for modulating the immune response. Based on available published research, this review aims to address the application of potential strategies in the intensive care unit, supplemented with current therapeutics by the administration of probiotics, prebiotics, and fecal microbiota transplant, to reduce post-surgical complications of sepsis/ARDS in critically ill patients.
危重病会导致人体肠道微生物群发生显著变化，进而导致肠道屏障功能破坏，这在多器官功能障碍的发病机制中起作用。脓毒症/急性呼吸窘迫综合征（ARDS）患者的肠道微生物群节律严重失调，这在肠道源性感染和肠道生态失调的发展中起相当大的作用。尽管最近医学有所发展，但术后并发症仍与高发病率和死亡率相关。细菌移位，即细菌和细菌产物穿过肠道屏障的移动，被证明是脓毒症背后的一种机制。目前的研究集中在通过解决导致肠道生态失调的重要因素来找到解决方案，而肠道生态失调随后会导致多器官衰竭，进而导致死亡。然而，对危重病患者的微生物群进行调控以提高治疗效果可能具有挑战性。益生菌调控有利于维持肠道屏障防御和调节免疫反应。基于现有的已发表研究，本综述旨在探讨在重症监护病房应用潜在策略，并通过施用益生菌、益生元及粪便微生物群移植来补充当前疗法，以减少危重病患者脓毒症/ARDS的术后并发症。
