title: Enteral nutritional therapy with pre, pro and symbiotic and gastrointestinal tract and inferior airway colonization in mechanically ventilated patients.
abstract: OBJECTIVE
  Sepsis is the main cause of death in the intensive care unit. New preventive measures for nosocomial infections have been researched, such as pre, pro and symbiotic usage, due to its immunoregulatory properties. The objective was to evaluate the effect of administration of pre, pro and symbiotic on gastrointestinal and inferior airway colonization and on nosocomial infections, particularly ventilator-associated pneumonia.
  
  
  METHODS
  Patients who were admitted to the intensive care unit at Hospital Universitário Clementino Fraga Filho between November 2004 and September 2006 and mechanically ventilated were randomized in one of four groups: control (n = 16), prebiotic (n = 10), probiotic (n = 12) or symbiotic (n = 11). Treatment was administered for fourteen days. Outcomes measured were: a) Colonization of the gastrointestinal tract and trachea; b) incidence of nosocomial infections, particularly ventilator associated pneumonia; c) duration of mechanical ventilation, length of stay in the intensive care unit, duration of hospitalization, mortality rates, and d) development of organ dysfunction.
  
  
  RESULTS
  Forty-nine patients were evaluated. intensive care unit's mortality was 34% and in-hospital mortality was 53%, APACHE II median was 20 (13 -25). The groups were matched at admission. There was no difference between the groups in relation to the incidence of ventilator associated pneumonia or nosocomial infection. There was a non-significant increase in the proportion of enterobacteria in the trachea at the seventh day in the pre and probiotic groups compared to control. There was a non-significant decrease in the number of bacteria found in the stomach in the pre, pro and symbiotic group at day 7. No significant difference, in regards to the remaining measured parameters, could be found.
  
  
  CONCLUSIONS
  Probiotic therapy was not efficient in the prevention of nosocomial infection but there was a tendency to reduction in tracheal colonization by non-fermenting bacteria.
authors.affiliation: Unidade Neurointensiva, Hospital Copa D'Or, Rio de Janeiro, RJ, Brasil.
authors.forename: Cássia Righy
authors.initials: CR
authors.lastname: Shinotsuka
authors.affiliation: Unidade Neurointensiva, Hospital Copa D'Or, Rio de Janeiro, RJ, Brasil.
authors.forename: Marta Ribeiro
authors.initials: MR
authors.lastname: Alexandre
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Cid Marcos Nascimento
authors.initials: CM
authors.lastname: David