Suzie Ferrie and Mark Daley Controlled Trial GG as Treatment for Diarrhea During Enteral Feeding in Critical Illness : Randomized

D iarrhea is a common problem in critically ill patients. The reported incidence of diarrhea in enterally fed intensive care unit (ICU) patients varies according to the criteria used to define diarrhea, but may be between 15% and 40% or higher. It can be a serious clinical problem , with potential significant detrimental effects on fluid and electrolyte balance, hemodynamic stability, skin integrity , wound healing, and nutrition status. Bowel management protocols can reduce the incidence of diarrhea, 1 but probiotics remain an untested treatment in the ICU setting. Probiotics are defined as beneficial bacteria found in a healthy human gut. 5 Critical illness is likely to cause significant disturbance to the gut microbiota because of the effects of the illness itself 6 as well as various interventions , including antibiotics and gastric acid suppressants, and medications that alter gut motility. The systemic inflammatory response affects gut motility and absorption and thus can contribute to diarrhea. Probiotics may have beneficial effects in ICU patients, including modulation of immune function and inflammatory response, 7 improvement in gut barrier function, 8 and prevention of coloniza-tion by harmful bacteria. Many studies support the effectiveness of probiotics (particularly Lactobacillus rham-nosus GG [LGG] and Saccharomyces boulardii) in preventing antibiotic-associated diarrhea, 12-15 including in critically ill patients, 16 but in everyday clinical practice, it is more common to administer probiotics only once the diarrhea has started. Although there is some evidence that such treatment of established diarrhea can reduce the duration and/or severity of diarrhea in children, 17,18 there are very few supportive studies of probiotic therapy in adults with diarrhea 19,20 and no published studies of probiotics as a diarrhea treatment in critically ill patients. A difficulty with probiotic studies is the large number of different bacterial species available, singly and in various combinations. It is possible that there are disease-specific benefits confined to particular species. LGG was selected for this study because of its strong antibacterial effects, 21 its ability to colonize the gut during antibiotic Background: Diarrhea is a common problem in critical illness. The aim of this study was to investigate the effect of probiotic treatment with Lactobacillus rhamnosus GG on established diarrhea in critically ill patients. Methods: This prospective ran-domized blinded trial in the adult intensive care unit of a large tertiary referral teaching hospital compared probiotic treatment with placebo. Thirty-six consecutive critically ill enterally fed adults with diarrhea were randomized …