Pro-, pre- and synbiotics for the prevention of incidental ventilator-associated pneumonia among critically ill patients: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Objectives

This study investigated the preventive effects of pro-, pre- and synbiotics on ventilator-associated pneumonia (VAP) among critically ill patients.

Methods

The PubMed, Web of Science, Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for relevant articles written before 19 February 2022. Only randomized controlled trials (RCTs) comparing the clinical efficacy of pro-, pre- and synbiotics with placebos or standard treatments for the prevention of incidental VAP were included.

Results

A total of 15 RCTs were included. Patients receiving pro-, pre- and synbiotics had a lower risk than the control group of contracting VAP (risk ratio [RR], 0.70; 95% CI, 0.57–0.85; I² = 67%). The duration of mechanical ventilation was significantly shorter in the study group than in the control group (mean difference [MD], −1.61 days; 95% CI, −2.72 to −0.50; I² = 86%), and the study group had a shorter duration of stay in the intensive care unit than the control group did (MD, −1.72 days; 95% CI, −3.22 to −0.23; I² = 87%).

Conclusions

Pro-, pre- and synbiotics can prevent VAP and the use of probiotics for patients who are critically ill should be supported.

KEYWORDS:

• Intensive care unit
• mechanical ventilation
• mortality
• prebiotics
• probiotic
• synbiotic
• ventilator-associated pneumonia

Author contributions

Conception: SHL, CCL, SHH, WTL.

Study design: SHL, CCL, SPC, LCL.

Analysis and interpretation: SHL, SPC, LCL.

Drafted or written: CCL, SHH and WTL.

Substantially revised or critically review: SHH and WTL.

All authors have agreed on the journal to which the article will be submitted and reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. In addition, all authors agree to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.