2012 OPEN FORUM Abstracts
PROBIOTIC ADJUNCTIVE SUPPLEMENTATION IN SURGICAL CRITICAL CARE.
Roger W. Reichenbach1, Michael Malian2, Arika Peck2, Nik Pamukov1; 1Respiratory Care, Henry Ford Health System, Detroit, MI; 2Acute Care Surgery, Henry Ford Health System, Detroit, MI
Background:Clostridium difficile(C.diff.)infection remains a problem in the Surgical Intensive Care Unit (SICU ).When Infection from C. diff. occurs it is not uncommon for patients to have co-morbid Health Care Associated Pneumonia (HCAP). Probiotics have been purported to reduce the severity of antibiotic induced colitis from C. diff. and possibly the incidence of HCAP.Hypothesis:We hypothesized that the addition of probiotics in addition to evidenced based algorithms in the treatment of infection in the SICU will allow for decreased ventilator days, decreased ICU length of stay LOS).Design: Prospective Masked Randomized Control Trial of Culturelle (Amerifit) Lactobacillus GG (LGG ) (75mg Lactobacillus rhamnosus ATCC #53103, 20 billion CFUs) vs. placebo given orally or by Gastric/PEG tube. Setting: 40 bed SICU in a 1000 bed University Affiliated Urban Hospital Methods:(n=74 )Subjects were enrolled In the SICU and had diarrhea defined as greater than three loose stools in a twenty four hour period.Immunocompromized subjects were excluded. Subjects who consented in the study received either Lactobacillus or a placebo, were enrolled within seventy two hours of experiencing symptoms of diarrhea and remained in the study until discharge.Standard treatment algorithms were used for management of Diarrhea, Infection, HCAP, Daily Ventilator Bundle assessment/weaning.Demographic and Clinical Data were collected including Apache II scores, Respiratory/ Stool/ other Cultures,SICU LOS,Ventilator days, use of antibiotics and resolution of HCAP/ diarrhea.Results:Total subjects (n=74).Subjects with APACHE II scores < 20 on ventilators with diarrhea and pneumonia who completed treatment (n=21); Mean Vent days of 14 in the Lactobacillus treated group vs.18 days in the placebo group.The Mean SICU LOS of the Lactobacillus group was comparable at 30 vs. 29 in the placebo group.Conclusion: There were no identifiable negative effects associated with Probiotic supplementation, an identifiable advantage to Probiotic supplementation was resolution of diarrhea.Probiotic supplementation did appear to have a positive impact on our study population as evidenced by decreased Ventilator days (Mean of 4) with very little impact on SICU LOS.We were not able to meet our study target of one hundred and eighty patients for statistical significance. Further large scale multi-center studies are needed to validate our observations. Sponsored Research - None Comparison of Subjects(n=21 ) Lactobacillus (LGG ) vs Placebo ( Mean APACHE II / Mean LOS/Mean VENT DAYS