Probiotics can prevent pneumonia in children on ventilators

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How long will I have to stay in hospital?

Every parent’s first thought when their child has to go to hospital is ‘how long will it be before they are home…’ Millions of children are hospitalized in Britain and the US every year. Of those, a high percentage will need help breathing at some point during their stay. Ventilation is not without risks and many children on ventilators end up staying longer in hospital due to respiratory infections.

Mechanical breathing

Mechanical breathing to help patients who cannot breathe sufficiently on their own is usually one of two forms. The patient can be helped by a doctor, nurse or other health professional, using a bag or bellows system to aid breathing; or a ventilator machine is used. Mechanical ventilation is called ‘invasive’ if a tube has to be inserted through the mouth or the skin to introduce air into the lungs. Usually ventilators are only used for only a short time, such as during an operation or when a child is critically ill in an intensive care unit. However, it seems it is still long enough for cases of ventilator associated pneumonia to occur.

What is ventilator associated pneumonia (VAP)?

Ventilator associated pneumonia is the commonest problem seen in children on mechanical breathing. The problem  lengthens the time that a child  can spend in intensive care unit, and increases the risk of a poor outcome.  VAP is different to the common form of pneumonia because it is not viral, nor fungal, and it is often caused by bacteria that are resistant to antibiotics.

Why does VAP happen in sterile conditions?

The tubes that are used to assist breathing, push oxygen into the lower part of the lungs and bacteria that are already in the body can travel down to the lungs.  The bacteria might already be present in the mucus lining of the child’s bronchial tubes and trachea and this enables them to move down further. In addition, the little hairs (cilia) that usually move mucus up the tubes, so that it can be ‘coughed’ out , can be damaged by too much oxygen, leaving the bacteria to grow.  There is also some indication that bacteria in the sinuses, stomach or blood stream can travel to the lungs.

New evidence on probiotics to prevent VAP

A new study published this month has shown that probiotics can be used to prevent ventilator associated pneumonia in children.  The study included a 150 children in intensive care, that needed mechanical breathing assistance for at least 48 hours. Half of the children were given probiotics as a prophylactic, and the other half were not. The probiotics were given twice a day during their time in intensive care and for a total of 7 days. VAP was seen in only 17.1% of the children on probiotics compared to 48.6% in the other group.  After statistical analysis the team could conclude that the VAP cases were reduced by 77% through the use of probiotics.  The time in intensive care was reduced by an average of 2.1 days and the time in hospital by an average of 3.3 days.

Unfortunately, Patient QI could find no information on the probiotic that was used. Further studies using an expanded probiotic spectrum could well lower the 17.1% of infections even further.

Banupriva et al. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med. Feb 2015.

 

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