Probiotics in the intensive care unit

PURPOSE OF REVIEW: To examine current knowledge regarding the utility of probiotics in a variety of medical conditions afflicting critically ill patients in the intensive care unit (ICU). RECENT FINDINGS: Recent experimental and clinical studies have furthered our understanding regarding the use of probiotic therapy across various clinical conditions. These disorders include antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. Although each of these conditions is germane to ICU patients, few studies have specifically studied this vulnerable population. The current data supporting the use of probiotics in the treatment of these different clinical conditions consist mostly of the results of small, single-center trials with varying quality of research design. Although recent studies have also generally demonstrated favorable results, one well designed study in severe pancreatitis found increased mortality with probiotic therapy. These results emphasize the need for improved data regarding mechanisms of action as well as rigorous attention to safety monitoring during the execution of probiotic clinical trials. SUMMARY: Data supporting the use of probiotics in different clinical conditions are variable in scope and quality. Large, well designed, randomized, multicenter trials are needed to better define the role and safety of probiotics in critically ill patients.