PrebioticsProbioticsSynbiotics.pdf

6.2 Enteral Nutrition (Other): Prebiotics/Probiotics/Synbiotics May 27th 2009 Recommendation: There are insufficient data to make a recommendation on the use of Prebiotics/Probiotics/Synbiotics in critically ill patients. Discussion: The committee noted the inconsistent effect of Prebiotics/Probiotocs/Synbiotics on mortality and the lack of a treatment effect on other clinical outcomes. There was inconsistency between studies in the method of reporting other outcomes such as septic morbidity, complications and diarrhea. Also there was a huge variation in the type of probiotics used, the use of prebiotics and the choice of a control group. Given this and the potential for increased harm in critically ill patients as evidenced by the recent PROPATRIA trial (1) and previous concerns specifically saccharomyces boulardii (2), the committee decided there was not enough evidence to support the use of Prebiotics/Probiotocs/Synbiotics. However, it was noted that their use may be associated with a trend towards a reduction in diarrhea in the critically ill population. (1) Besselink MG at al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Feb 23;371(9613):651-9. (2) Lherm T, Monet C, Nougiere B, Soulier M, Larbi D, Le Gall C, Caen D, Malbrunot C. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med. 2002 Jun;28(6):797-801. Values Definition Score 0, 1, 2 or 3 Effect size Magnitude of the absolute risk reduction attributable to the intervention listed--a higher score indicates a larger effect size 0 Confidence interval 95% confidence interval around the point estimate of the absolute risk reduction, or the pooled estimate (if more than one trial)--a higher score indicates a smaller confidence interval 1 Validity Refers to internal validity of the study (or studies) as measured by the presence of concealed rand