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BACKGROUND & AIMS: This review investigated whether the administration of enteral pre-, pro- and synbiotics compared with controls in adult intensive care unit (ICU) patients reduced the incidence of nosocomial infections, length of ICU stay, hospital mortality and specifically pneumonia. METHODS: Systematic review of randomised controlled trials comparing enteral feeding and pre-, pro- or synbiotics, versus standard enteral feed alone, in patients admitted to adult ICUs. RESULTS: Eight randomised studies with a total of 999 critically ill adult patients met the inclusion criteria. Pre- pro- or synbiotics were not associated with any significant change in the outcomes studied-length of ICU stay, hospital mortality and the incidence of nosocomial infection and more specifically pneumonia incidence. Few data were available for other outcomes. CONCLUSIONS: The use of pre- pro- or synbiotics in adult critically ill patients confers no statistically significant benefit in the outcome criteria studied. There is currently a lack of evidence to support the use of pre- pro- or synbiotics in patients admitted to adult ICUs, and a large well-designed trial is needed in this area.

Original publication




Journal article


Clin nutr

Publication Date





182 - 192


Critical Care, Critical Illness, Cross Infection, Enteral Nutrition, Hospital Mortality, Humans, Length of Stay, Pneumonia, Probiotics, Randomized Controlled Trials as Topic