Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis
Background and Objective: Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of...
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doaj-1823cb86b1914124aa1356b9d0a210712020-11-24T20:59:05ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122017-10-01810.3389/fphar.2017.00717298880Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential AnalysisHong Weng0Hong Weng1Jian-Guo Li2Zhi Mao3Ying Feng4Chao-Yang Wang5Xue-Qun Ren6Xian-Tao Zeng7Xian-Tao Zeng8Center of Evidence Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Urology, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Critical Care Medicine, Chinese PLA General Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, ChinaCenter of Evidence Based Medicine, Huaihe Hospital of Henan University, Kaifeng, ChinaCenter of Evidence Based Medicine, Huaihe Hospital of Henan University, Kaifeng, ChinaCenter of Evidence Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Urology, Zhongnan Hospital of Wuhan University, Wuhan, ChinaBackground and Objective: Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients.Methods: PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs) comparing probiotics with control in mechanically ventilated patients were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated with fixed or random effects models. Trial sequential analysis (TSA) was performed using TSA 0.9beta software.Results: Thirteen RCTs (N = 1969) were included. Overall, probiotics were associated with reduced incidence of VAP (RR = 0.73, 95% CI = 0.60–0.89; P = 0.002), which was confirmed by TSA (TSA adjusted 95% CI = 0.55–0.96). However, no significant difference was observed in 90-day mortality (RR = 1.00, 95% CI = 0.72–1.37; P = 0.99), overall mortality (RR = 0.84, 95% CI = 0.70–1.02; P = 0.09), 28-day mortality (RR = 1.06, 95% CI = 0.72–1.57; P = 0.99), intensive care unit (ICU) mortality (RR = 0.97, 95% CI = 0.74–1.27; P = 0.82), hospital mortality (RR = 0.81, 95% CI = 0.65–1.02; P = 0.07), diarrhea (RR = 0.99, 95% CI = 0.83–1.19; P = 0.92), length of ICU stay (MD = −2.40 days, 95% CI = −6.75 to 1.95; P = 0.28), length of hospital stay (MD = −1.34 days, 95% CI = −6.21 to 3.54; P = 0.59), and duration of mechanical ventilation (MD = −3.32 days, 95% CI = −6.74 to 0.09; P = 0.06).Conclusions: In this meta-analysis, we found that probiotics could reduce the incidence of VAP in mechanically ventilated patients. It seems likely that probiotics provide clinical benefits for mechanically ventilated patients.http://journal.frontiersin.org/article/10.3389/fphar.2017.00717/fullprobioticsventilator-associated pneumoniameta-analysistrial sequential analysisrandomized-controlled trial |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hong Weng Hong Weng Jian-Guo Li Zhi Mao Ying Feng Chao-Yang Wang Xue-Qun Ren Xian-Tao Zeng Xian-Tao Zeng |
spellingShingle |
Hong Weng Hong Weng Jian-Guo Li Zhi Mao Ying Feng Chao-Yang Wang Xue-Qun Ren Xian-Tao Zeng Xian-Tao Zeng Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis Frontiers in Pharmacology probiotics ventilator-associated pneumonia meta-analysis trial sequential analysis randomized-controlled trial |
author_facet |
Hong Weng Hong Weng Jian-Guo Li Zhi Mao Ying Feng Chao-Yang Wang Xue-Qun Ren Xian-Tao Zeng Xian-Tao Zeng |
author_sort |
Hong Weng |
title |
Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis |
title_short |
Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis |
title_full |
Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis |
title_fullStr |
Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis |
title_full_unstemmed |
Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis |
title_sort |
probiotics for preventing ventilator-associated pneumonia in mechanically ventilated patients: a meta-analysis with trial sequential analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pharmacology |
issn |
1663-9812 |
publishDate |
2017-10-01 |
description |
Background and Objective: Ventilator-associated pneumonia (VAP) is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients.Methods: PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs) comparing probiotics with control in mechanically ventilated patients were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated with fixed or random effects models. Trial sequential analysis (TSA) was performed using TSA 0.9beta software.Results: Thirteen RCTs (N = 1969) were included. Overall, probiotics were associated with reduced incidence of VAP (RR = 0.73, 95% CI = 0.60–0.89; P = 0.002), which was confirmed by TSA (TSA adjusted 95% CI = 0.55–0.96). However, no significant difference was observed in 90-day mortality (RR = 1.00, 95% CI = 0.72–1.37; P = 0.99), overall mortality (RR = 0.84, 95% CI = 0.70–1.02; P = 0.09), 28-day mortality (RR = 1.06, 95% CI = 0.72–1.57; P = 0.99), intensive care unit (ICU) mortality (RR = 0.97, 95% CI = 0.74–1.27; P = 0.82), hospital mortality (RR = 0.81, 95% CI = 0.65–1.02; P = 0.07), diarrhea (RR = 0.99, 95% CI = 0.83–1.19; P = 0.92), length of ICU stay (MD = −2.40 days, 95% CI = −6.75 to 1.95; P = 0.28), length of hospital stay (MD = −1.34 days, 95% CI = −6.21 to 3.54; P = 0.59), and duration of mechanical ventilation (MD = −3.32 days, 95% CI = −6.74 to 0.09; P = 0.06).Conclusions: In this meta-analysis, we found that probiotics could reduce the incidence of VAP in mechanically ventilated patients. It seems likely that probiotics provide clinical benefits for mechanically ventilated patients. |
topic |
probiotics ventilator-associated pneumonia meta-analysis trial sequential analysis randomized-controlled trial |
url |
http://journal.frontiersin.org/article/10.3389/fphar.2017.00717/full |
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