A Prospective Study Conducted In Intensive Care Unit: The Effect Of Probiotics In Mechanically Ventilated Patients

OBJECTIVE:In order to find some clues to prevention and cure patients undergoing mechanical ventilator away from ventilator-associated pneumonia scientifically and effectively, we carried out the test In order to explore that, 1)the effects of probiotics use in Mechanically Ventilated Patients outcomes in ICU,2)the effect of application of probiotics on pH value of gastric juice and gastric bacteria colonization,3)comparison the pathogenic bacteria and the homology of them in different parts in the research process,4)the distribution and drug resistance of pathogens of VAP.METHOD:Eligible patients admitted to intensive care unit from December 2011 to May 2014 were enrolled and randomly divided into control group and probiotic s treatment group.The patients in probiotics treatment group receive probiotics treatment (2g tid) when they accept mechanical ventilation immediately while patients in control group receive no probiotics.Record the gastric juice pH value, gastric bacterial colonization gastrointestinal bleeding and diarrhea. Then if patients diagnosed with ventilator-associated pneumonia clinically,take out the bronchoalveolar lavage fluid cultureand identification and susceptibility tests. At the same time analysis the general data of patients,such as gender, age, acute physiology and chronic health evaluation,albumin, procalcitonin, the mechanical ventilation timetime, mortality,the cost of occupancy during ICU.Compare the homology between gastric bacterial coloaization and VAP pathogen as well as the incidence of VAP,prognosis and cost of antibiotics between control group and treatment group.RESULT:Totally 126 eligible patients involved in the study. In two groups, the incidence of early onset VAP, Late onset VAP and patients without VAP are respectively 17.5%(11/63),20.6%(13/63),61.9%(39/63);16.9%(11/65),36.9% (24/65),46.2%(30/65).Among the two groups there are no difference in the incidence rate of VAP, but the incidence rate of late onset of the control group is higher compared with the treatment group (X2=4.130, P<0.05); The ratio of gastric juice pH below 4 in treatment group (68.0%,138/203) was higher than that of control group(58.3%,126/216),(P<0.05);the ratio of gastric bacterial colonization in treatment group was lower than that in control group,(P<0.01);The homo logy ratio between VAP pathogen and colonization bacteria in treatment group (18.5%,5/27) was lower than that in control group(50%,16/36),(P<0.01). Acinetobacter baumannii and pseudomonas aeruginosa are the mainly pathogenic bacteria of VAP. There was no significant difference in mechanical ventilation time,7 days mortality ratio,the cost of treatment in icu in two groups (P>0.05). Among 75 cases of pathogenic bacteria detected in patients developing VAP gram negative bacilli accounting for 85.3% of all the strains. The main pathogenic bacteria are Bauman Acinetobacter (26.7%) and Pseudomonas aeruginosa (26.7%), Escherichia coli (13.5%), most of them are multi drug resistant strains.CONCIUSION:1)application of probiotics can reduce the incidence of late VAP, without increasing the number of days of mechanical ventilation, the mortality rate, occupancy costs during ICU.2) the high pH value of gastric juice are the risk factor for VAP, probiotics can maintain suitable pH value of it, reduce gastrointestinal colonization bacteria, reducing ventilator-associated pneumonia from Gastro-pulmonary pathway.3)The main pathogenic bacterium of VAP is multi resistant gram negative bacilli, Bauman Acinetobacter has increasing trend.