Table 2 Randomized controlled trials evaluating the effect of pre, pro or synbiotics on feeding tolerance of enterally fed critically ill patients
Author, year | Population | Design | JADAD score | EN protocol | Type of intervention | ||
|---|---|---|---|---|---|---|---|
Delivery vehicle | Intervention /dose/duration | control | |||||
Bleichner et al., 1997 [17] | ICU patients n=128 | Parallel | 5 | NR | NGT or jejunostomy | EN (intact protein standard diet without fiber or lactose) + Saccharomyces boulardii /500 mg four times a day/limited to 21 days or to the withdrawal of EN | EN (intact protein standard diet without fiber or lactose) + placebo |
Schultz et al., 2000 [18] | ICU patients n=44 | Parallel | 2 | NR | Tube feeding | Fiber containing formula+ pectin or fiber-free formula +pectin/ 20ml, twice daily/ 6 days | Fiber containing formula+ placebo Or fiber-free formula +placebo |
Spapen et al., 2001 [19] | ICU patients with severe sepsis or septic shock n= 25 | Parallel | 3 | Start: first 24h, 25cc/h. Increase 25–35 cc/h to 80% target | NGT | EN+ partially hydrolyzed guar/ 22g/l / a maximum of 21 days or to the withdrawal of EN | Fiber-free EN |
Rushdi et al., 2004 [20] | ICU patients with persistent diarrhea n=20 | Parallel | 3 | Start: first 18–24h. Target: 25–35 kcal/kg. First day: 50%, second day: 75%, third day: 100% | NJT | EN+ 2% soluble guar gum (Benefiber)/ 4 days | Fiber-free EN |
Knight et al., 2009 [21] | ICU patients n= 259 | Parallel | 5 | Start: 30cc/h; max: 80cc/h; increase or decrease according to GRV | NGT/ OGT | EN (Nutrison Energy) + Synbiotic 2000 FORTE / twice a day/ to the earliest of the following time point:28 days after admission, death or discharge | EN (Nutrison Energy) + placebo |
Frohmader et al., 2010 [22] | ICU patients n= 45 | Parallel | 5 | Start: first 24h, 20cc/h; increase: 20cc/4h to target. Target: 25–35 kcal/kg | NGT/ OGT/ nasojejunostomy | Fiber-free EN+ probiotic (VSL#3) /twice a day/ mean of 11.9 days | Fiber-free EN+ placebo |
Barraud et al., 2010 [23] | ICU patients with MV n=167 | Parallel | 5 | Starting in the first 24h, 10 kcal/kg, increase to 30–35 kcal/kg | NGT | EN + multi-strain probiotic (Ergyphilus)/ once a day/ until successful weaning (maximum of 28 days) | EN + placebo |
Morrow et al., 2010 [24] | ICU patients with MV n=167 | Parallel | 5 | NR | NGT | EN + probiotic (Lactobacillus rhamnosus GG) / twice a day/ | EN+ inulin-based placebo |
Ferrie and Daley, 2011 [25] | ICU patients with diarrhea n= 36 | Parallel | 5 | NR | Gastric tube | Fiber containing EN+ probiotic (inulin-based Lactobacillus GG)/twice a day/ 7 days | Fiber containing EN+ placebo (inulin) |
Sanaie et al., 2014 [26] | ICU patient n= 40 | Parallel | 5 | Start in first 24h, 25cc/h; increase 25cc/4h to target. Target: 25–30 kcal/kg | NGT | Fiber containing EN+ probiotic (VSL#3)/ twice daily/ 7 days | Fiber containing EN+ placebo |
Majid et al., 2014 [27] | ICU patients n= 22 | Parallel | 5 | Energy estimation based on Schofield equation | NGT | Fiber containing EN+ additional oligofructose/inulin/ 7g per day/ 7days | Fiber containing EN+ placebo |
Malik et al., 2016 [28] | ICU patients n= 60 | Parallel | 5 | 25 kcal/kg. start in first 24–48h, with GRV management | NGT | EN+ multi-strain probiotic/ twice a day/ 7 days | EN+ placebo |
Fazilaty et al., 2018 [29] | Multiple trauma ICU patients n= 40 | Parallel | 5 | Goal: 25–30 kcal/kg, 75% in the 48h | NGT | EN+ prebiotic (oat β-glucan)/ 3g per day/ 21 days | EN+ placebo (maltodextrin) |
Shimizu et al., 2018 [30] | Septic ICU patients with MV n= 72 | Parallel | 3 | Start: 20cc/h; increase: 20cc/h/day to target. Target: 25–30 kcal/kg | NGT | EN +multi-strain probiotic (Yakult BL Seichoyaku) 3 g per day+ prebiotic (galactooligosaccharides) 10g per day/ until EN stop | EN |
Tuncay et al., 2018 [31] | Neurocritical care patients n=46 | Parallel | 1 | Start: 10cc/h; increase: 10cc/8h till 20cc/h; requirement: Schofield equation+stress factor+activity factor+ ventilator support+fever+TEF | Nasofeeding, gastrostomy/PEG | EN with prebiotic content/ 21 days | EN |