1. BACKGROUND & OBJECTIVES:
ROLE OF PROPHYLACTIC PROBIOTIC THERAPY ON CONSTIPATION IN CRITICALLY ILL PATIENTS : A RANDOMISED, DOUBLE-BLIND, PLACEBO CONTROLLED PILOT STUDY
PC085
Wan Aizat Wan Zakaria1, Hazreen Abdul Majid2, M.Shahnaz Hasan1, Mohd Fadhil Hadi Jamaluddin1, Mazuin Kamarul Zaman2, Vineya Rai* 1
1Anesthesiology, 2Social and Preventive Medicine, UNIVERSITY OF MALAYA, KUALA LUMPUR, Kuala Lumpur, Malaysia
BACKGROUND & OBJECTIVES:
Constipation in critically ill patients may cause failure of enteral feeding, failure to wean from mechanical ventilation, subsequently prolonging ICU stay and increased mortality. Probiotics are defined by the WHO as “live microorganisms, which when administered in adequate amount, confer a health benefit to the host”. The production of short-chain fatty acids such as acetate, propionate and butyrate by probiotic bacteria Bifidobacterium and Lactobacillus has been thought to improve intestinal peristalsis which eventually leads to a decrease in the colonic transit time, increased stool frequency and stool consistency. The production of secretory IgA and IgG by probiotic bacterias also act as a barrier against pathogenic bacterial translocation, especially of gram-negative organisms. The objective of this study is to evaluate the prophylactic effect of probiotic therapy in reducing the incidence of constipation in critically ill patients.
RESULTS
The probiotic group showed shorter time for first bowel opening of 2.43 days compared with 2.86 days for the placebo group, higher mean frequency of bowel opening of 1.10 times/day compared with 0.79 times/day in the placebo group, and less use of stimulant laxatives. However, they presented with a higher gastric aspirate. The length of ICU stay was shorter by 2 days, and the number of days requiring mechanical ventilation for the group that received probiotics showed a mean of 3.1 days compared with 4.4 days for the placebo group.
Figure 1: Mean Comparison of Interleukin-6 (IL-6) between Whey and Casein Group
Table 1: Comparing timing, frequency of bowel movement and use of laxatives between placebo and probiotic group
Figure 2: Median Difference of C-Reactive Protein (CRP) between Whey and Casein Group
Placebo
Probiotic
p value
Timing of first bowel opening (day)
2.86 (2.19)
2.43 (1.98)
0.708
Frequency of bowel opening/day (n)
0.79 (0.64)
1.10 (0.74)
0.711
Yes : No
6 (85.7%) : 1 (14.3%)
4 (57.1%) : 3 (42.9%)
0.559
Table 2 : Comparing gastric residual volume, number of ventilator days, length of ICU stay and deaths
MATERIALS & METHODS
A total of 14 patients who required mechanical ventilation and enteral nutrition for more than 3 days were randomised into two groups : the intervention group who received a probiotic preparation, or the control group who received placebo. The patients were monitored for 7 consecutive days. The timing of first bowel movement, stool frequency and consistency were recorded and summarised into a daily stool score based on the King’s Stool Chart.
Placebo
Probiotic
p value
Gastric Residual Volume (ml/day)
62.24 (39.8)
79.38 (139.9)
0.162
Number of days on ventilator (days)
4.43 (1.98)
3.14 (1.06)
0.158
Length of ICU stay (days)
14.43 (5.99)
12.43 (4.27)
0.486
Hospital deaths Yes : No
4 (57.1%) : 3 (42.9%)
2 (28.6%) : 5 (71.4%)
0.592
CONCLUSION
Although the results were statistically insignificant, nonetheless it has demonstrated a positive outcome. Therefore it can be concluded that prophylactic use of probiotics may have a role in reducing the rate of constipation in critically ill patients. However, subsequent research has to be carried out with a larger sample size.