“Uso de probióticos en pacientes críticos”

Contenido principal del artículo

Ana Cecilia Vittal
Nazarena Asús

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 recomendado

Detalles del artículo

Cómo citar
1.
Vittal AC, Asús N. “Uso de probióticos en pacientes críticos”. Rev Arg de Ter Int. [Internet]. 31 de julio de 2017 [citado 22 de noviembre de 2024];34(2):53-9. Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/523
Sección
Revisiones

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 críticamente enfermo. Un consenso de práctica clínica. Grupo de Trabajo de Abordaje Nutricional en el Paciente Crítico. 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