Evaulation of Lactobacillus Therapy on Duration of Mechanical Ventilation in Critically Ill Adult Patients

Introduction:

Intestinal microbiome maintains the integrity of the gut mucosa via both the enhancement of immune functions and the prevention of opportunistic and/or pathogenic micro-organism infections.  Critically-ill patients often suffer the ramifications resulting from medication and/or inflammation induced suppression of these beneficial bacterial functions.  Supplementing patients with probiotics, in an attempt to restore normal gut homeostasis, is thought to both assist critically-ill patients with recovery and, subsequently, decrease the duration of artificial ventilation.

Objectives: Effect/s of the probiotic Lactobacillus Rhamnosus GG (LGG), e.g.,  ventilator free days, length of stay (LOS) and mortality in intensive care units, administered to ventilated critically-ill patients receiving enteral nutrition (EN) in a community hospital will be evaluated.

Study Design: This is a minimal-risk, prospective, observational study meant to examine approximately 100 patients partitioned into two groups of critically-ill patients receiving EN therapy: Group 1 (control group) and Group 2 (recipients of probiotic therapy).

Methods: Inclusion criteria: 1) patient age (18 years), 2) EN initiated within 72 hours of ICU admission, and 3) anticipated therapy for at-least 48 hours. Exclusion criteria: 1) inability to be fed through the gastrointestinal tract, 2) contra-indication to LGG or any of the ingredients found in Culturelle®, 3) known/reported history of LGG or probiotic infection, 4) concurrent/ anticipated therapy with mannitol or lactulose, 5) short gut syndrome, 6) current immunosuppressive therapy, and 7) patient not anticipated to survive past 7 days.  Group 2 patients will receive LGG via capsules of the commercially available product Culturelle®.

Results: To date, data has been collected for the control group. Patients (n=70) had an average APACHE II score of 19.5, and medical complications being the primary reason for admission to the ICU.  Average time on ventilator was 7.7 days.  Average ICU and hospital LOS were 10 and 14.4 days.  

Conclusions: Anticipated completion by April 2016.