Effectiveness Of Probiotics For Prevention Of Ventilator-associated Pneumonia:A Systematic Review

Objective:To systematically evaluate the efficacy and safety of probiotics for prevention of ventilator associated pneumonia.Methods: Search in web of science,Pubmed,OVID,Cochrane,Lib,CNKI,EMbase,Sciencedirect,Chinese biomedical database(CBM),and Wanfang database before August 2017 and hand searching the relevant data resources,collected for randomized controlled trials of probiotics for prevention of ventilator-associated pneumonia(RCT),using a modified version of the Jadad scale to evaluate the quality of the included studies,Meta-analysis was performed with RevMan 5.3 software.Results: A total of 16 RCTs,using probiotics can reduce the incidence of VAP [RR=0.71,95%CI(0.62,0.80);P<0.00001],ICU days [MD=-3.28,95%CI(-6.15,-0.41);P=0.03]and antibiotics,but can not reduce the mortality of ICU [RR=0.99,95%CI(0.74,1.32);P=0.94],hospital mortality[RR=0.77,95%CI(0.58,1.01);P=0.06],28-day mortality [RR= 1.01,95%CI(0.69,1.47);p=0.97],90-day mortality [RR= 1.00,95% CI(0.72,1.37);p=0.99],hospital stays [MD =-0.68,95%CI(-3.88,2.52);P=0.68],duration of mechanical ventilation [MD=-2.17,95% CI(-4.78,0.44);P=0.10],and the incidence of diarrhea [RR=0.96,95%CI(0.80,1.14);P=0.62].No serious adverse events were reported in all included RCTs.Conclusion: The use of probiotics can reduce the incidence of VAP,but it has no effect on the mortality,hospital stay,duration of mechanical ventilation and the incidence of diarrhea.However,considered the heterogeneity of research designs,there is a need for more rigorous,large sample randomized controlled studies to increase the strength of evidence.