益生菌有助於預防CAP

吃兩個capsule, 一個灌漿到口中，一個灌到NG裏
如果有效，比什麼subglottic suction要來得實際多了
下次來試試看，吃益生菌的人PDRAB會不會消失得比較快…!

Probiotics and Ventilator-Associated Pneumonia

In a blinded, randomized study involving 138 mechanically ventilated patients, Lactobacillus administered to the oropharynx and gastrointestinal tract significantly reduced VAP incidence.

Ventilator-associated pneumonia (VAP) develops in up to 30% of patients receiving mechanical ventilation. The pathogenesis is presumed to involve colonization of the aerodigestive tract and subsequent aspiration of contaminated secretions. Probiotics could potentially have a role in reducing VAP incidence by maintaining the aerodigestive microbial balance, but evidence to support this possibility is limited.

To explore the issue further, researchers conducted a randomized, double-blind trial among adult patients at a Nebraska hospital who were receiving mechanical ventilation and were likely to require it for >72 hours. The 146 patients received two capsules of Lactobacillus rhamnosus GG (each containing 109 colony-forming units) or placebo twice daily. The contents of one capsule were mixed with saline and applied as a slurry to the oropharynx; the contents of the second capsule were suspended in sterile water and given through a nasogastric tube.

In a modified intent-to-treat analysis involving 138 patients, 50 patients developed VAP, according to clinical criteria. Of these, 17 had received Lactobacillus and 33 had received placebo (P<0.001).>Lactobacillus recipients versus 28 placebo recipients (P=0.007). In addition, Lactobacillus treatment delayed the time to development of microbiologically confirmed VAP (P<0.001)>Clostridium difficile–associated diarrhea (P<0.02).>Lactobacillus. The cost of therapy was US$2.13 daily.

Comment: In a group of patients requiring long-term mechanical ventilation, use of Lactobacillus reduced the rates of clinical and microbiologically confirmed VAP and delayed the time to VAP onset, all at a relatively low cost. These effects were presumably achieved by reducing colonization with pathogenic organisms.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases November 10, 2010

Citation(s):

Morrow LE et al. Probiotic prophylaxis of ventilator-associated pneumonia: A blinded, randomized, controlled trial. Am J Respir Crit Care Med 2010 Oct 15; 182:1058.

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