Probiotic mitigates gut hypoperfusion-associated acute gastrointestinal injury in patients undergoing cardiopulmonary bypass

1. In this randomized controlled trial, preoperative probiotic supplementation was associated with a reduced incidence of acute gastrointestinal injury (AGI) and nosocomial infections and shorter ICU stay time. 

Evidence Rating Level: 1 (Excellent) 

Past studies have shown a strong connection between the gut microbiome and cardiovascular health. Previous research has shown that gut microbiota can play a role in cardiovascular disease (CVD), so modifying it could affect the risk of such conditions. More specifically, previous studies have found that acute gastrointestinal injury (AGI) is associated with negative outcomes after CPB. Some recent work has shown the benefits of probiotics in improving prognosis through gut modulation. To assess this, the study employed a double-blinded randomized controlled trial to determine if the use of preoperative probiotic supplementation could reduce the incidence of AGI and improve recovery after CPB surgery. Individuals were included if they were between the ages of 18 to 70, had moderate to severe congestive heart failure or heart valve disease undergoing HVR with CPB. The eligible patients were then randomized 1:1 to either receive probiotics (Lac group) or a placebo (placebo group). Blood samples were collected at 24 h and 72 h post-operation, while fecal samples were collected daily. After meeting eligibility criteria, a total of 52 patients were included, with 26 assigned to the Lac group and 26 to the placebo group. The Lac group had a significantly lower incidence of AGI (15.38%) compared to the placebo group (42.31%) (P=0.032). Patients in the Lac group also had shorter ICU stay times (5 [4, 5.5] vs. 6 [5, 19], P=0.041) and a lower incidence of nosocomial infections compared to the placebo group (11.54% vs. 34.62%, P=0.048). Upon examining the risk factors, probiotic supplementation emerged as the only protective factor against the occurrence of AGI (OR 0.079; 95% CI, 0.007-0.861, P=0.037). These findings support the implementation of preoperative probiotic supplementation as a strategy to reduce the incidence of AGI following CPB. 

Click to read the study in BMC Medicine

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