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General Critical Care

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Probiotics, comprising beneficial live microorganisms, possess the ability to modify gut microbiota. They are thought to enhance enteral feeding tolerance (EFI) and decrease hospital-acquired infections in critically ill patients. A randomized control clinical study sought to evaluate the effectiveness of synbiotics in improving EFI and oropharyngeal aspiration in patients in intensive care units (ICU). A total of 105 critically ill patients in the ICU of a tertiary referral hospital associated with a medical university participated in this randomized clinical trial. Participants were randomly assigned to either a synbiotic group or a control group, with the investigation lasting seven days. The primary outcome was a reduction in gastric residual volume, suggesting an improvement in EFI. Secondary outcomes included the necessity for prokinetics, occurrence of aspiration, duration of mechanical ventilation, length of ICU stay, and the patient's level of consciousness.

The findings of this clinical trial revealed that synbiotic intervention resulted in a significant decrease in the need for prokinetics (P=0.019), fewer oropharyngeal aspirations (P=0.01), enhanced bolus administration volume, and a decline in gastric residual volume throughout the seven-day evaluation period. Patients who were given synbiotics experienced an elevated level of consciousness (P=0.01). This clinical trial demonstrated that administering synbiotics from the onset of enteral feeding notably diminished the requirement for prokinetics, reduced oropharyngeal aspiration, lowered gastric residual volume, increased bolus administration volume, and consequently, improved enteral feeding tolerance.

Dehghani. Investigating the effect of oral synbiotic on enteral feeding tolerance in critically ill patients: A double-blinded controlled clinical trial of gut microbiota. Nutr Clin Pract 2023;38(2):402-410

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