Department of Intensive Care Medicine, No. 903 Hospital of PLA Joint Logistic Support Force, Hangzhou, China.
Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, China.
Adv Clin Exp Med. 2023 Jun;32(6):633-642. doi: 10.17219/acem/157407.
According to reports, ventilator-associated pneumonia affects critically ill patients more frequently than any other nosocomial infection. Probiotic usage as a prophylactic intervention has shown promising results in numerous studies.
We performed a meta-analysis to evaluate the effect of probiotics on different parameters in critically ill ventilated subjects.
A systematic literature search up to June 2022 was performed and 5893 critically ill ventilated subjects at the baseline of the studies were identified; 2912 of them were using the probiotics, and there were 2981 controls. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were calculated to assess the effect of probiotics on different parameters in critically ill ventilated subjects using the dichotomous and contentious methods with a random or fixed effects model.
The probiotics caused a significantly lower incidence of ventilator-associated pneumonia (OR = 0.52; 95% CI: 0.40-0.68, p < 0.001), shorter duration of mechanical ventilation (MD = -2.22; 95% CI: -3.33--1.11, p < 0.001), shorter intensive care unit (ICU) stay (MD = -2.09; 95% CI: -3.41--0.77, p = 0.002), shorter hospital stay (MD = -2.36; 95% CI: -4.54--0.19, p = 0.03), and lower oropharyngeal colonization (OR = 0.59; 95% CI: 0.36-0.96, p = 0.03) in critically ill ventilated subjects compared with controls. However, probiotic use had no significant difference in terms of diarrhea incidence (OR = 0.74; 95% CI: 0.52-1.07, p = 0.11) and in-hospital mortality (OR = 0.90; 95% CI: 0.79-1.03, p = 0.14) in critically ill ventilated subjects compared with controls.
Probiotics caused a significantly lower ventilator-associated pneumonia incidence, shorter duration of mechanical ventilation, shorter ICU and hospital stay, and lower oropharyngeal colonization. However, there was no significant difference in terms of diarrhea incidence and in-hospital mortality in subjects who used probiotics compared with controls. The low sample size of 9 out of 27 researches and the small number of studies in several comparisons requires attention when analyzing the results.
据报道，呼吸机相关性肺炎比任何其他医院获得性感染更常影响危重症患者。益生菌的使用作为一种预防干预措施，在许多研究中显示出有前景的结果。
我们进行了一项荟萃分析，以评估益生菌对重症机械通气患者不同参数的影响。
系统检索截至 2022 年 6 月的文献，确定了 5893 名处于研究基线的重症机械通气患者；其中 2912 名使用了益生菌，2981 名为对照组。使用二项和分类方法，采用随机或固定效应模型，计算比值比（OR）和均数差值（MD）及其 95%置信区间（95%CI），以评估益生菌对重症机械通气患者不同参数的影响。
益生菌的使用显著降低了呼吸机相关性肺炎的发生率（OR=0.52；95%CI：0.40-0.68，p<0.001），缩短了机械通气时间（MD=-2.22；95%CI：-3.33--1.11，p<0.001）、重症监护病房（ICU）入住时间（MD=-2.09；95%CI：-3.41--0.77，p=0.002）和住院时间（MD=-2.36；95%CI：-4.54--0.19，p=0.03），降低了口腔定植（OR=0.59；95%CI：0.36-0.96，p=0.03）。然而，与对照组相比，益生菌的使用在腹泻发生率（OR=0.74；95%CI：0.52-1.07，p=0.11）和院内死亡率（OR=0.90；95%CI：0.79-1.03，p=0.14）方面无显著差异。
益生菌的使用显著降低了呼吸机相关性肺炎的发生率，缩短了机械通气时间、ICU 和住院时间，降低了口腔定植。然而，与对照组相比，使用益生菌的患者在腹泻发生率和院内死亡率方面无显著差异。由于 27 项研究中有 9 项的样本量较小，且在几个比较中研究数量较少，因此在分析结果时需要注意这一点。
