Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan.
Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK.
Nutrients. 2022 Apr 12;14(8):1600. doi: 10.3390/nu14081600.
Presently, there is conflicting evidence regarding the efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). This meta-analysis was conducted to update current clinical evidence and evaluate the efficacy and safety of probiotics for the prevention of VAP.
We searched three databases and two trial registers to retrieve randomised controlled trials (RCTs) comparing probiotics or synbiotics with placebo or standard treatment for the prevention of VAP in adult patients receiving mechanical ventilation in the intensive care unit (ICU).
Our meta-analysis included 18 RCTs involving 4893 patients. Our results showed that probiotics may reduce the incidence of VAP (RR 0.68, 95% CI: 0.55-0.84; low certainty). However, in our subgroup and sensitivity analyses, the effect was not significant in double-blind studies, and in studies with a low risk of bias in the randomisation process. Probiotics reduced the length of ICU stay (MD -2.22 days, 95% CI: -4.17 to -0.28; moderate certainty) and the duration of antibiotic use (MD -1.25 days, 95% CI -1.86 to -0.64; moderate certainty).
Probiotics may reduce the incidence of VAP but due to the low quality of pooled evidence, the use of probiotics warrants caution. Further, large-scale, high-quality RCTs need to be conducted to provide conclusive evidence.
目前，关于益生菌在预防呼吸机相关性肺炎（VAP）中的疗效存在相互矛盾的证据。本荟萃分析旨在更新当前的临床证据，并评估益生菌预防呼吸机相关性肺炎的疗效和安全性。
我们检索了三个数据库和两个试验注册处，以检索比较益生菌或合生剂与安慰剂或标准治疗用于预防 ICU 机械通气患者 VAP 的随机对照试验（RCT）。
我们的荟萃分析纳入了 18 项 RCT，涉及 4893 名患者。我们的结果表明，益生菌可能降低 VAP 的发生率（RR 0.68，95%CI：0.55-0.84；低确定性）。然而，在我们的亚组和敏感性分析中，双盲研究和随机过程低偏倚风险的研究中效果不显著。益生菌可缩短 ICU 住院时间（MD -2.22 天，95%CI：-4.17 至-0.28；中等确定性）和抗生素使用时间（MD -1.25 天，95%CI：-1.86 至-0.64；中等确定性）。
益生菌可能降低 VAP 的发生率，但由于汇总证据质量较低，益生菌的使用需要谨慎。此外，需要进行大规模、高质量的 RCT 以提供确凿的证据。
