• Terence J Frohmader, Wendy P Chaboyer, Iain K Robertson, and John Gowardman.
• Intensive Care Unit, Launceston General Hospital, Launceston, Tasmania, Australia. terry.frohmader@dhhs.tas.gov.au
• Am. J. Crit. Care. 2010 May 1; 19 (3): e1-11.

BackgroundDiarrhea has adverse consequences for critically ill patients, health care staff, and health care costs.ObjectiveTo 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.MethodsA 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.ResultsThe 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.ConclusionVSL#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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