Roles of microbiota manipulations in the ICU

The intestinal microbiota displays dramatic changes in the ICU patient, with a loss of the entire beneficial lactic bacterial flora. In situations of hyperinflammation followed by immune paresis that are due to the acute disease but also to chronic diseases and drugs used, it is crucial to reestablish inflammatory and immune homeostasis, and microbiota manipulations with probiotics or synbiotics is an instrument of choice. It is not recommended to give any ICU patient any probiotic or synbiotic, for fear of inefficacy or even increased mortality. However, there is strong evidence in elective surgery, polytrauma and acute pancreatitis for well-defined formulations of bacterial strains and fibers. The inflammatory response is immediate and therefore administration of probiotics or synbiotics in these situations must also be immediate. (C) 2009 Elsevier Masson SAS. All rights reserved.