Document Type : Research articles
Authors
1
Professor Emeritus Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University.
2
Clinical Instructor Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University
3
Professor Critical Care Medicine, Critical Care Medicine Department, Faculty of Medicine, Alexandria University.
4
Assistant Professor Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University.
Abstract
Background: The management of critical illness in the contemporary intensive care units
(ICUs) creates an adverse environment in the gut of the critically ill and alters the
microbiome. Numerous endogenous and iatrogenic factors causing a state of dysbiosis,
which is the state of microbiome imbalance, this leading to translocation of pathogens
and facilitate the emergence of systemic inflammatory response (SIRS), sepsis, and
multiple organ dysfunction syndrome (MODS). It should come as no surprise that the gut
is the primary source and contributor of nosocomial sepsis and MODS in critically ill
patients, which is the main factor affecting the prognosis of patients in the ICUs. In order
to restore the homeostasis of the microbiome, several nutritional strategies have been
evaluated with the aim to improve the outcomes, including probiotics that are currently
being used. Because the positive benefits of probiotics in several clinical trials, the
understanding of how probiotics enhance the outcomes of enterally fed critically ill
patents is therefore crucial. Objective: To identify the effect of natural probiotics on the
enterally fed critically ill patients’ outcomes. Settings: This study was conducted in the
general ICUs at Alexandria Main University Hospital, unit I (11 beds), unit II (12 beds),
and unit III (16 beds). Subjects: a convenience sample of 60 newly admitted
mechanically ventilated adult patients who started orogastric or nasogastric tube feeding
within the 24 to 48 hours from admission. Tools: One tool was used to collect the data in
this study namely "Probiotics and non-probiotics enterally fed critically ill patients’
assessment record". Results: Findings of the present study illustrated significant
reduction in the incidence of VAP (P=0.020), ICU length of stay and mortality rate
(P=0.023). However, this intervention had a minimal impact on the other variables with
no significant statistical difference between both groups, in relation to vomiting,
diarrhea, feeding intolerance, constipation, UTI, and the duration on mechanical
ventilation among enterally fed critically ill patients (P=1.000, 0.371, 0.371, 0.080,
0.559, 0.706 respectively). Conclusion: The present study concluded that administration
of natural probiotics to enterally fed critically ill patients seemed to confirm positive
outcomes. Recommendations: Adopt the use of the natural probiotics for the enterally
fed critically ill patients in the ICUs. Conduct more trials to identify the optimum
bacterial strain, timing, duration, and dosing for each health problem.
Keywords
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