title: [The influence of symbiotics in multi-organ failure: randomised trial].
abstract: OBJECTIVE
  To assess whether the administration of symbiotic preparations in patients with multi-organ failure (MOF) diminishes the evolution of the failure, the inflammatory response generated, the colonization pattern and the Intensive Care Unit (ICU) infectious illness.
  
  
  METHODS
  Randomized and controlled trial. All patients with MOF were included. Neutropenia and acute pancreatitis patients were excluded. A symbiotic (Simbiotic Drink) was administered via enteral feeding during the first 7 days. Variables of interest were: Sequential Organ Failure Assessment (SOFA) score evolution, systemic concentrations of lactate, fibrinogen and D-dimer; skin and mucosa colonization and infectious disease register.
  
  
  RESULTS
  Eighty-nine patients were included; 46 in the symbiotic group (SG) and 43 in the control group (CG). There were 68.5% males, with a median age of 69 years. There were no significant differences in the patients' fundamental characteristics (medical history, age, reason for admission, severity scores), nor in the length of ICU stay or in mortality. Comparing the SG with the CG, there were lower lactate levels on the second day, more fibrinogen levels on the days 5 and 7, and lower D-dimer levels on the day 7. Eight hundred and ninety-five cultures were performed for colonization assessment, with isolation of 528 microorganisms. No differences in microbiological resistance were found; there were more colonization in the SG by Candida in mucous membranes after the third day; this situation resolved after stopping symbiotic administration. Twenty-two patients suffered an infectious disease in ICU, 14 in SG (42.4%) and 19 in CG (57.6%). Although no differences were found in the microbiological pattern, there was a predominance of Candida spp. over other microorganisms (4 vs. 0 cases).
  
  
  CONCLUSIONS
  The symbiotic preparation Simbiotic Drink, administered in MOF, results in differences to improve the early lactate levels and late fibrinogen/D-dimer levels as well as mucosa colonization by Candida. There were no differences in the ICU evolution.
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Ismael
authors.initials: I
authors.lastname: López de Toro Martín-Consuegra
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España. Electronic address: mmsc16@gmail.com.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Sanchez-Casado
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: M José
authors.initials: MJ
authors.lastname: Pérez-Pedrero Sánchez-Belmonte
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: López-Reina Torrijos
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Sánchez-Rodriguez
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Raigal-Caño
authors.affiliation: Servicio de Microbiología, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Eva
authors.initials: E
authors.lastname: Heredero-Galvez
authors.affiliation: Servicio de Microbiología, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Susana Brea-
authors.initials: SB
authors.lastname: Zubigaray
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: M Ángeles
authors.initials: MÁ
authors.lastname: Arrese-Cosculluela
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000818:Animals; D001644:Bifidobacterium; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D004043:Dietary Fiber; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007441:Intubation, Gastrointestinal; D007778:Lactobacillus; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology / Q000628:therapy*; D010288:Parenteral Nutrition; D056692:Prebiotics; D019936:Probiotics / Q000008:administration & dosage / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012121:Respiration, Artificial; D048249:Streptococcus thermophilus
chemical_list: D004043:Dietary Fiber; D056692:Prebiotics; D054328:Proton Pump Inhibitors
keywords: Disfunción multiorgánica; Ensayo clínico; Intensive Care Unit; Multi-organ failure; Probiotics; Probióticos; Simbiotics; Simbióticos; Trial; Unidad de Cuidados Intensivos
vernacular_title: Influencia de los simbióticos en la disfunción multiorgánica: ensayo aleatorizado.