A prospective randomised trial of probiotics in critically ill patients.
OBJECTIVE
Probiotics exert a beneficial effect on the host through modulation of gastrointestinal microflora. The aim of this study was to investigate the effect of the probiotic Lactobacillus plantarum 299v on gut barrier function and the systemic inflammatory response in critically ill patients.


METHODS
One hundred and three critically ill patients were randomised to receive an oral preparation containing L. plantarum 299v (ProViva) in addition to conventional therapy (treatment group, n = 52) or conventional therapy alone (control group, n = 51). Serial outcome measures included gastric colonisation, intestinal permeability (lactulose/rhamnose dual-sugar probe technique), endotoxin exposure (IgM EndoCAb), C-reactive protein and Interleukin 6 levels.


RESULTS
L. plantarum had no identifiable effect on gastric colonisation, intestinal permeability, endotoxin exposure or serum CRP levels. There were no differences between the groups in terms of septic morbidity or mortality. On day 15 serum IL-6 levels were significantly lower in the treatment group compared to controls.


CONCLUSIONS
The enteral administration of L. plantarum 299v to critically ill patients was associated with a late attenuation of the systemic inflammatory response. This was not accompanied by any significant changes in the intestinal microflora, intestinal permeability, endotoxin exposure, septic morbidity or mortality.
McNaught
Clare E
CE
Department of Surgery, Combined Gastroenterology Research Group, Scarborough Hospital, Woodlands Drive, Scarborough, North Yorkshire YO12 6QL, UK.
Woodcock
Nicholas P
NP
Anderson
Alexander D G
AD
MacFie
John
J
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004731:Endotoxins; D005260:Female; D005753:Gastric Mucosa / Q000276:immunology / Q000382:microbiology; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000517:prevention & control*; D015850:Interleukin-6 / Q000096:biosynthesis; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology*; D048191:Lactiplantibacillus plantarum / Q000254:growth & development* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011183:Postoperative Complications / Q000517:prevention & control; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D004731:Endotoxins; D015850:Interleukin-6; D002097:C-Reactive Protein