title: The use of pre- pro- and synbiotics in adult intensive care unit patients: systematic review.
abstract: OBJECTIVE
  This review investigated whether the administration of enteral pre-, pro- and synbiotics compared with controls in adult intensive care unit (ICU) patients reduced the incidence of nosocomial infections, length of ICU stay, hospital mortality and specifically pneumonia.
  
  
  METHODS
  Systematic review of randomised controlled trials comparing enteral feeding and pre-, pro- or synbiotics, versus standard enteral feed alone, in patients admitted to adult ICUs.
  
  
  RESULTS
  Eight randomised studies with a total of 999 critically ill adult patients met the inclusion criteria. Pre- pro- or synbiotics were not associated with any significant change in the outcomes studied-length of ICU stay, hospital mortality and the incidence of nosocomial infection and more specifically pneumonia incidence. Few data were available for other outcomes.
  
  
  CONCLUSIONS
  The use of pre- pro- or synbiotics in adult critically ill patients confers no statistically significant benefit in the outcome criteria studied. There is currently a lack of evidence to support the use of pre- pro- or synbiotics in patients admitted to adult ICUs, and a large well-designed trial is needed in this area.
authors.affiliation: Intensive Care Society Trials Group, Kadoorie Centre, Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. peter.watkinson@nda.ox.ac.uk
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Watkinson
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Barber
authors.forename: Paul
authors.initials: P
authors.lastname: Dark
authors.forename: J Duncan
authors.initials: JD
authors.lastname: Young
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection; D004750:Enteral Nutrition / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic