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American Journal of Critical Care. 2010;19: 1-11 doi:10.4037/ajcc2010976
Copyright © 2010 by the American Association of Critical-Care Nurses.
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Decrease in Frequency of Liquid Stool in Enterally Fed Critically Ill Patients Given the Multispecies Probiotic VSL#3: A Pilot Trial

By Terence J. Frohmader, MCCN (Hons), Wendy P. Chaboyer, PhD, Iain K. Robertson, MPH and John Gowardman, FRACP, FJFICM. Terence J. Frohmader is a clinical nurse at Launceston General Hospital, Launceston, Tasmania, Australia. Wendy P. Chaboyer is the director of the Research Centre for Clinical and Community Practice Innovation, Griffith University, Queensland, Australia. Iain K. Robertson is a senior research fellow in the School of Human Life Sciences, University of Tasmania, Launceston, and a biostatistician at Clifford Craig Medical Research Trust, Tasmania. John Gowardman is a senior staff specialist in the intensive care unit at Royal Brisbane and Women’s Hospital, Brisbane, Queensland, a senior lecturer at the University of Queensland, and an adjunct associate professor at Griffith University.

Corresponding author:Terry Frohmader, Intensive Care Unit, Level 5, Launceston General Hospital, Charles St, Launceston, Tasmania, 7250 (e-mail: terry.frohmader{at}dhhs.tas.gov.au).

Background Diarrhea has adverse consequences for critically ill patients, health care staff, and health care costs.

Objective To evaluate the efficacy of the multispecies probiotic VSL#3 in reducing the mean number of episodes of liquid stool in enterally fed critically ill patients.

Methods A single-center, double-blind, randomized, placebo-controlled pilot study was done in a 6-bed intensive care unit in a 330-bed public hospital in Australia. A total of 45 adults (20 intervention, 25 control) who required enteral nutrition for more than 72 hours were given VSL#3 or a placebo twice daily. The frequency (mean number of episodes per patient per day) and weight (grams per day) were determined for both liquid stool and liquid and loose (unformed) stool.

Results The 2 groups of patients had no demographic or clinical differences. Patients received enteral nutrition for a mean of 8.5 days (SD, 5.4) and were studied for a mean of 11.9 days (SD, 5.6). Compared with the control group, the intervention group had a significant reduction in the frequency of liquid stools (incidence rate ratio, 0.50; 95% confidence interval, 0.27 to 0.93; P = .03). Smaller but still significant differences also occurred between the groups in both the frequency of episodes and the weight of liquid and loose (unformed) stool.

Conclusion VSL#3 was effective in reducing the frequency of liquid stool in critically ill patients receiving enteral nutrition. Probiotics possibly can minimize diarrhea in critically ill tube-fed patients, but more controlled clinical trials are needed.






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Copyright © 2010 by the American Association of Critical-Care Nurses.