title: Effects of probiotic therapy in critically ill patients: a randomized, double-blind, placebo-controlled trial.
abstract: 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.
authors.affiliation: Royal Alexandra Hospital, Edmonton, Canada, University of Alberta, Edmonton, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Alberda
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.forename: Jon
authors.initials: J
authors.lastname: Meddings
authors.forename: Catherine
authors.initials: C
authors.lastname: Field
authors.forename: Linda
authors.initials: L
authors.lastname: McCargar
authors.forename: Demetrios
authors.initials: D
authors.lastname: Kutsogiannis
authors.forename: Richard
authors.initials: R
authors.lastname: Fedorak
authors.forename: Karen
authors.initials: K
authors.lastname: Madsen
mesh_terms: 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*
chemical_list: D010919:Placebos