“Uso de probióticos en pacientes críticos”
Contenido principal del artículo
Resumen
Los probióticos son microorganismos vivos que ingeridos en una dosis y cepa adecuada proveen efectos beneficiosos al huésped.
El intestino cumple un rol muy importante en relación a la inmunidad del paciente. En el paciente críticamente enfermo las funciones inmunológicas se encuentran alteradas por distintas causas, como puede ser la propia inflamación, el uso de antibióticos, la translocación bacteriana. La administración de algunas cepas probióticas ha demostrado ser beneficioso para mantener el buen funcionamiento del epitelio intestinal y así disminuir la posibilidad de contraer diversas infecciones características de los pacientes internados en la UCI.
Si bien ha sido estudiada la inocuidad y el beneficio de algunas cepas probióticas en esta población de pacientes, actualmente su uso rutinario no es recomendadoDetalles del artículo
La revista no retiene los derechos de reproducción (copyright) por lo que los autores pueden volver a publicar sus trabajos con la sola mención a la fuente original de publicación.
Citas
Food and Agricultural Organization of the United Nations and World Health Organization. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. World Health Organization [online], http://who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf. 2001. Consultado 23 de setiembre de 2016.
Morrow LE, Gogineni V, Malesker MA. Probiotics in the intensive care unit. Nutr Clin Pract. 2012;27(2): 235-41 http://journals.sagepub.com/doi/abs/10.1177/0884533612440290?url_ver=Z39.88-
&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
Latorre M, Krishnareddy S, Freedberg DE. Microbiome as mediator: Do systemic infections start in the gut? World J Gastroenterol.2015; 21(37): 10487-10492. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588071/pdf/WJG-21-10487.pdf
Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Crit Care 2016;19:262. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991010/pdf/13054_2016_Article_1434.pdf
McDonald D, Ackermann G, Khailova L, Baird C, Heyland D, Kozar R, et al. Extreme dysbiosis of the microbiome in critical illness. mSphere. 2016;1(4).pii: e00199-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007431/pdf/mSphere.00199-16.pdf
Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr. 2011;35(1):43-9. http://journals.sagepub.com/doi/pdf/10.1177/0148607110370705
Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: A blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010; 182(8):1058–1064 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970846/pdf/AJRCCM18281058.pdf
Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012;40(12):3290-302.
Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest.2013;143(3):646-55 http://www.sciencedirect.com/science/article/pii/S0012369213601439
Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10:CD009066. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009066.pub2/epdf
Zeng J, Wang CT, Zhang FS, Qi F, Wang SF, Ma S, et al. Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med. 2016;42(6):1018-28.
Tan M, Zhu JC, Du J, Zhang LM, Yin HH. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study. Crit Care. 2011;15(6):R290. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388628/pdf/cc10579.pdf
Kenna J, Mahmoud L, Zullo AR, Potter NS, Fehnel CR, Thompson BB, et al. Effect of probiotics on the incidence of healthcare-associated infections in mechanically ventilated neurocritical care patients. Nutr Clin Pract. 2016;31(1):116-20.
Gu WJ, Deng T, Gong YZ, Jing R, Liu JC. The effects of probiotics in early enteral nutrition on the outcomes of trauma: a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr. 2013;37(3):310-317.
Zhang Y, Chen J, Wu J, Chalson H, Merigan L, Mitchell A. Probiotic use in preventing postoperative infection in liver transplant patients. Hepatobiliary Surg Nutr. 2013;2(3):142-147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924667/pdf/hbsn-02-03-142.pdf
Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371(9613):651-659
Zhang MM, Cheng JQ, Lu YR, Yi ZH, Yang P, Wu XT. Use of pre-, pro and synbiotics in patients with acute pancreatitis: a meta-analysis. World J Gastroenterol. 2010;16(31):3970-3978. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923773/pdf/WJG-16-3970.pdf
Wang G, Wen J, Xu L, Zhou S, Gong M, Wen P, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res. 2013;183(2):592-597.
Gou S, Yang Z, Liu T, Wu H, Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2014;18(2):R57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056604/pdf/cc13809.pdf
Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005;115(1):178-81.
Morrow LE, Gogineni V, Malesker MA. Synbiotics and probiotics in the critically ill after the PROPATRIA trial. Curr Opin Clin Nutr Metab Care. 2012;15(2):147-50.
Bongaerts GP, Severijnen RS. A reassessment of the PROPATRIA study and its implications for probiotic therapy. Nat Biotechnol. 2016;34(1):55-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496732/pdf/pone.0048811.pdf
Boyle RJ, Robins-Browne RM, Tang ML. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr. 2006;83(6):1256-64 http://ajcn.nutrition.org/content/83/6/1256.full
Lherm T, Monet C, Nougiere B, Soulier M, Larbi D, Le Gall C, et al. Seven cases of fungemia with saccharomyces boulardii in critically ill patients. Intensive Care Med. 2002;28(6):797-801.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159-
http://journals.sagepub.com/doi/pdf/10.1177/0148607109335234
Soporte nutricional en el paciente adulto crÃticamente enfermo. Un consenso de práctica clÃnica. Grupo de Trabajo de Abordaje Nutricional en el Paciente CrÃtico. Asociación Argentina de Nutrición Enteral y Parenteral Comité de Soporte Nutricional y Metabolismo. Sociedad Argentina de Terapia Intensiva. RCAN Rev Cubana Aliment Nutr 2016;26(1 Supl1):S1:S82. http://www.revicubalimentanut.sld.cu/Vol_26_1_Suplemento_1/Introduccion_Consenso.pdf
Canadian clinical practice guidelines 2015 [consultado Sep 2016]. Disponible en: www.criticalcarenutrition.com