title: Probiotics and diarrhoea management in enterally tube fed critically ill patients--what is the evidence?
abstract: OBJECTIVE
  The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients.
  
  
  BACKGROUND
  Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse.
  
  
  METHODS
  Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT).
  
  
  RESULTS
  Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use.
  
  
  CONCLUSIONS
  Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.
authors.affiliation: Queensland University of Technology, School of Nursing, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia. lc.jack@student.qut.edu.au
authors.forename: Leanne
authors.initials: L
authors.lastname: Jack
authors.forename: Fiona
authors.initials: F
authors.lastname: Coyer
authors.forename: Mary
authors.initials: M
authors.lastname: Courtney
authors.forename: Bala
authors.initials: B
authors.lastname: Venkatesh
mesh_terms: D016638:Critical Illness; D003967:Diarrhea / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects*; D006801:Humans; D019936:Probiotics / Q000627:therapeutic use*