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This study investigated the preventive effects of pro-, pre- and synbiotics on ventilator-associated pneumonia (VAP) among critically ill patients. The PubMed, Web of Science, Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for relevant articles written before 19 February 2022. Only randomized controlled trials (RCTs) comparing the clinical efficacy of pro-, pre- and synbiotics with placebos or standard treatments for the prevention of incidental VAP were included. A total of 15 RCTs were included. Patients receiving pro-, pre- and synbiotics had a lower risk than the control group of contracting VAP (risk ratio [RR], 0.70; 95% CI, 0.57–0.85;  I2  = 67%). The duration of mechanical ventilation was significantly shorter in the study group than in the control group (mean difference [MD], −1.61 days; 95% CI, −2.72 to −0.50;  I2  = 86%), and the study group had a shorter duration of stay in the intensive care unit than the control group did (MD, −1.72 days; 95% CI, −3.22 to −0.23;  I2  = 87%). Pro-, pre- and synbiotics can prevent VAP and the use of probiotics for patients who are critically ill should be supported.

expert review of anti-infective therapy

Pro-, pre- and synbiotics for the prevention of incidental ventilator-associated pneumonia among critically ill patients: a systematic review and meta-analysis of randomized controlled trials