Synbiotics (prebiotics and probiotics) in the nutrition of critically ill patients

Abstract

Background: It is well known, nowadays, that intestinal microbiota is considered to be a synbiotic partner that maintains the host’s health. Probiotics are live microorganisms and prebiotics are selectively fermentable non-digestible oligosaccharides or food ingredients that when adequately present, provide health benefit for the host. The mechanisms in which these microorganisms are involved are gastrointestinal barrier function improvement, gut flora modification by antimicrobial peptides inducted by host cells, antimicrobial factors released by probiotics, epithelial adherence competition, and immunomodulation that advantages the host. Synbiotics are a synergic combination of probiotic bacteria and prebiotic ingredients that promote the growth of the former. Methods: In the present study, the existing evidence regarding the beneficial role of probiotics, prebiotics, and synbiotics in critically ill patients was evaluated. Results: The results were rather encouraging about the early use of pro/pre/synbiotics in daily care of critically ill patients but still controversial due to the lack of specific supportive evidence and strain specificity. Conclusions: Despite the positive effect of pro/pre/synbiotics supplementation, they cannot be widely applied in critical care clinical practice until well-designed prospective and randomized controlled trials are performed.