SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Nutrition and Microbes
Role of Probiotics Supplementation in Preventing Ventilator-Associated Pneumonia among Critically Ill Patients: A Critical Umbrella Review of Meta-Analyses of Randomized Controlled Trials
Provisionally accepted
- 1Nanchang University Jiangxi Medical College, Nanchang, China
- 2Nanchang University Second Affiliated Hospital, Nanchang, China
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Background: In critically ill patients, gut microbiome balance is often disrupted by antibiotics and disease-related stress. Probiotics may strengthen gut barrier function and lower the risk of ventilator-associated pneumonia (VAP), but their effectiveness in mechanically ventilated patients remains unclear. This umbrella review synthesizes evidence from systematic reviews on probiotic therapy and VAP incidence. Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, Scopus, and CNKI for systematic reviews published from database inception to July 20, 2025. Data were extracted using a standardized form that had been pilot-tested prior to use. Data were synthesized using both narrative and quantitative approaches. The study protocol was registered in PROSPERO (registration ID: CRD420251034247). Results: This umbrella review included 24 meta-Analyses of randomized controlled trials ((RCTs) involving 92,711 mechanically ventilated critically ill patients. Using the AMSTAR 2 tool, the methodological quality varied: 4 were rated critically low, 12 low, 1 moderate, and 9 high. Probiotic supplementation was associated with a reduced risk of VAP (OR=0.67, 95% CI: 0.61–0.75; RR=0.74, 95% CI: 0.69–0.80) and nosocomial infections (OR=0.81, 95% CI: 0.73–0.90; RR=0.84, 95% CI: 0.80–0.88). Probiotics showed modest reductions in intensive care unit (ICU) stay (WMD=–1.30 days, 95% CI: –1.59 to–1.02), overall hospital stay (WMD=–1.29 days, 95% CI: –1.79 to –0.79), duration of mechanical ventilation (WMD=–1.64 days, 95% CI: –2.07 to –1.22), and antibiotic use (WMD=–1.26 days, 95% CI: –2.25 to –0.28). The risk of diarrhea decreased based on OR estimates (OR=0.77, 95% CI: 0.67–0.88), whereas RR estimates did not show a statistically significant difference (RR=0.98, 95% CI: 0.94–1.01). Probiotic use was associated with a statistically significant reduction in ICU mortality (OR=0.86, 95% CI: 0.79–0.94; RR=0.94, 95% CI: 0.90–0.98), whereas hospital mortality was reduced only in RR Analyses (RR=0.92, 95% CI: 0.88–0.97) and not in OR Analyses (OR=0.92, 95% CI: 0.84–1.01). Conclusion: Probiotics may offer potential benefits for mechanically ventilated, critically ill patients by reducing infections and improving certain clinical outcomes; however, the overall quality of the available evidence remains insufficient to support definitive conclusions.
Keywords: Critically ill, Preventing, Probiotics, Umbrella review, ventilator-associated pneumonia
Received: 06 Oct 2025; Accepted: 29 Dec 2025.
Copyright: © 2025 Jiang, Xiao, Zhou, Zhang, Xiong, Shen and Xiong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiao-yun Xiong
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