Synbiotics and the mucosal barrier in critically ill patients

Purpose of review Outcome in severe and critical illnesses is strongly related to premorbid conditions: the strength of the mucosal barriers, the innate immune system, and the built-in resistance to disease. Early risk factors and determinants of poor outcome are factors such advanced age; impaired premorbid health status, especially diabetes and high body mass index (obesity); and immunosuppressive treatments. Combined supplementation of bioactive fibers and lactic acid bacteria (synbiotics) directly and indirectly influences several of these factors. Recent findings Determinants for poor outcome are degree of oxidative stress, neutrophil activation, and infiltration of tissues, especially in the lungs. Attempts at early reduction of the exaggerated inflammatory storm and limitation of further impairment of the immune function are always given the highest priority. The supply of live lactic acid bacteria and plant fibers can dramatically reduce the hyperinflammation and also the infiltration by neutrophils of organs such as the lungs. New and efficient autopositioning and regurgitation-resistant feeding tubes provide instruments for the early supply of enteral nutrition with immune-boosting antioxidants and synbiotics. Summary A meticulous choice of probiotic lactic acid bacteria is recommended because only a small minority of the lactic acid bacteria survive the harsh environment of the upper gastrointestinal tract, ferment strong semiresistant fibers such as inulin, and have the ability to control inflammation and eliminate unwanted pathogens, such as antibiotic- resistant microorganisms and Clostridium difficile.