Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial.
BACKGROUND
Multiple organ dysfunction syndrome (MODS) is a major cause of mortality in intensive care units. A breakdown in gut barrier function and immune dysfunction are associated with the onset of MODS. Probiotic bacteria have been shown to modulate intestinal barrier and immune function.


OBJECTIVE
This study assessed the efficacy of a probiotic compound in a viable and nonviable formulation in modulating intestinal permeability and immune function and preventing the onset of MODS in patients in the intensive care unit.


METHODS
A double-blind, randomized controlled trial was conducted in the intensive care unit of a tertiary care teaching hospital. Twenty-eight critically ill patients admitted to the intensive care unit were randomly assigned to receive 1 of 3 treatments daily for 7 d: 1) placebo, 2) viable probiotics, or 3) equivalent probiotic sonicates. MODS scores and systemic concentrations of immunoglobulin (Ig) A and IgG were measured on days -1, 4, and 7, and intestinal permeability measurements were taken daily.


RESULTS
The patients responded to viable probiotics with a significantly larger increase in systemic IgA and IgG concentrations than in the patients who received placebo or sonicates (P < 0.05). MODS scores were not significantly affected by probiotic treatment. Over the study period, intestinal permeability decreased in most patients.


CONCLUSIONS
Patients receiving viable probiotics show a greater enhancement in immune activity than do patients receiving either placebo or probiotic bacterial sonicates.
Alberda
Cathy
C
Royal Alexandra Hospital, Edmonton, Canada, University of Alberta, Edmonton, Canada.
Gramlich
Leah
L
Meddings
Jon
J
Field
Catherine
C
McCargar
Linda
L
Kutsogiannis
Demetrios
D
Fedorak
Richard
R
Madsen
Karen
K
D018806:APACHE; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002153:Calorimetry, Indirect; D016638:Critical Illness / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy; D015596:Nutrition Assessment; D010919:Placebos; D019936:Probiotics / Q000627:therapeutic use*
D010919:Placebos