Probiotics to Reduce Ventilator Associated Pneumonia in Paediatric Population
Ventilator associated pneumonia (VAP) in paediatric intensive care unit (PICU) is associated with increased mortality and longer hospital stay. A non-placebo, non-blinded, open-label randomised controlled trial published in the journal Intensive Care Medicine investigated the potential of prophylactic probiotics in reducing the incidence of VAP in paediatric populations.
Critically ill children under 12 years of age likely to need mechanical ventilation for more than 48 hours were recruited. Based on the age groups, children were randomly allocated to the probiotics group and the control group. Probiotic capsules (6.6 billion colony-forming units of Lactobacillus, Bifidobacterium and Streptococcus thermophilus) were administered to the probiotic group, twice a day for seven days or until discharge. The control group did not receive either probiotics or placebo. On every third day or on clinical suspicion of VAP, complete haemogram, blood cultures, or tracheal aspirate cultures were analysed. Standard unit protocols were followed for treating patients with VAP.
Ventilator associated pneumonia was reported in 12 children in the probiotics group and acquired VAP in 35 children in the control group. Prophylactic probiotic administration reduced the incidence of VAP and VAP rates (22/1,000 ventilated days versus 39/1,000 ventilated days). The duration of ICU stay, mechanical ventilation and hospital stay was shorter in the probiotic group compared to the control group (mean reduction of 2.1 days, 1.7 days and 3.3 days, respectively). The colonisation rates of pathogenic microorganisms such as Klebsiella and Pseudomonas were significantly lower in the probiotic group. No adverse effects associated with intervention were reported.
Prophylactic probiotic administration in critically ill children was safe and effective in reducing the incidence of VAP in PICU patients in a setting where baseline VAP rates are high. The efficacy of probiotics needs to be further confirmed by larger multicentre trials in different settings.
News source - Banupriya B, Biswal N, Srinivasaraghavan R, et al. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med. 2015; 41(4):677-85.