Lactobacillus GG in the Prophylaxis of Ventilator Associated Pneumonia

NCT ID: NCT00613795

Last Updated: 2010-03-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

125 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-08-31

Study Completion Date

2009-11-30

Brief Summary

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This study utilizes lactobacillus, or probiotics, delivered twice daily to the mouth and stomach, via feeding tube, in effort to determine whether the oral administration of a naturally occurring Lactobacillus species reduces the incidence of ventilator associated pneumonia therefore reducing intensive care unit(ICU)complications.

Detailed Description

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The long-term objective of this research is to determine the utility of altering the oral and gastric bacterial flora in mechanically ventilated patients in order to reduce intensive care unit (ICU)complications. Specifically, our goal is to determine whether the oral administration of a naturally occurring Lactobacillus species reduces the incidence of ventilator associated pneumonia (VAP). ICU admission is commonly accompanied by overgrowth of the natural gastrointestinal (GI) and oropharyngeal flor by pathogenic organisms. Patients requiring endotracheal intubation are predisposed to developing VAP, presumably via micro-aspiration of the altered oropharyngeal flora. By reducing VAP rates, we hope to improve ICU outcomes, minimize ICU expenses, and most importantly, decrease morbidity and mortality.

Conditions

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Pneumonia Ventilator Associated Pneumonia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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1

Lactobacillus

Group Type ACTIVE_COMPARATOR

Lactobacillus GG

Intervention Type DIETARY_SUPPLEMENT

Every 12 hours, the contents of a single capsule containing Lactobacillus GG will be suspended in 3 ml of water-soluble jelly. The suspension will be applied to the oropharyngeal mucosa via sterile syringe. The contents of a second capsule will be suspended in 10 ml of sterile water and pushed through the NG tub followed by 10 mL of air to ensure complete administration.

2

placebo

Group Type PLACEBO_COMPARATOR

placebo

Intervention Type DIETARY_SUPPLEMENT

Every 12 hours, the contents of a single identical placebo capsule containing the inert plant carbohydrate inulin will be suspended in 3 ml of water-soluble jelly. This suspension will be applied to the oropharyngeal mucosa via sterile syringe. The contents of a second placebo capsule will be suspended in 10 ml of sterile water and pushed through eh NG tube followed by 10 mL of air to ensure complete administration

Interventions

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Lactobacillus GG

Every 12 hours, the contents of a single capsule containing Lactobacillus GG will be suspended in 3 ml of water-soluble jelly. The suspension will be applied to the oropharyngeal mucosa via sterile syringe. The contents of a second capsule will be suspended in 10 ml of sterile water and pushed through the NG tub followed by 10 mL of air to ensure complete administration.

Intervention Type DIETARY_SUPPLEMENT

placebo

Every 12 hours, the contents of a single identical placebo capsule containing the inert plant carbohydrate inulin will be suspended in 3 ml of water-soluble jelly. This suspension will be applied to the oropharyngeal mucosa via sterile syringe. The contents of a second placebo capsule will be suspended in 10 ml of sterile water and pushed through eh NG tube followed by 10 mL of air to ensure complete administration

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Admission to the medical, surgical, or cardiac ICU
* Age 19 years or greater (the age of majority in the state of Nebraska)
* Anticipated need for \>72 hours of endotracheal intubation
* Initial intubation during hospitalization
* Approval of the attending physician responsible for the patient's care
* Informed surrogate consent within 24 hours of intubation

Exclusion Criteria

* Pregnancy
* Pharmacologic immunosuppression (\>10mg prednisone daily or equivalent for at least 14 days)
* Native immunosuppression: 1)known HIV disease or AIDS, 2)history of malignancy, 3)multiple organ system failure
* History of prosthetic or bioprosthetic cardiac valve placement
* History of prosthetic vascular graft placement
* Cardiac trauma
* History of rheumatic fever, endocarditis, congenital cardia abnormality, or acquired cardia abnormality
* Gastroesophageal surgery or perforation associated with current admission
* Intestinal surgery or perforation associated with current admission
* Significant oropharyngeal mucosal injury
* Placement of a tracheostomy
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Creighton University

OTHER

Sponsor Role lead

Responsible Party

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Creighton University Medical Center

Principal Investigators

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Lee Morrow, MD

Role: PRINCIPAL_INVESTIGATOR

Assistant Professor of Medicine

Locations

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Creighton University Medical Center

Omaha, Nebraska, United States

Site Status

Countries

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United States

References

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Atherton ST, White DJ. Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet. 1978 Nov 4;2(8097):968-9. doi: 10.1016/s0140-6736(78)92530-8.

Reference Type BACKGROUND
PMID: 81991 (View on PubMed)

Ben-Menachem T, Fogel R, Patel RV, Touchette M, Zarowitz BJ, Hadzijahic N, Divine G, Verter J, Bresalier RS. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study. Ann Intern Med. 1994 Oct 15;121(8):568-75. doi: 10.7326/0003-4819-121-8-199410150-00003.

Reference Type BACKGROUND
PMID: 8085688 (View on PubMed)

Bengmark S, Gianotti L. Nutritional support to prevent and treat multiple organ failure. World J Surg. 1996 May;20(4):474-81. doi: 10.1007/s002689900075.

Reference Type BACKGROUND
PMID: 8662138 (View on PubMed)

Craven DE, Steger KA, Barber TW. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s. Am J Med. 1991 Sep 16;91(3B):44S-53S. doi: 10.1016/0002-9343(91)90343-v.

Reference Type BACKGROUND
PMID: 1928191 (View on PubMed)

Hatakka K, Savilahti E, Ponka A, Meurman JH, Poussa T, Nase L, Saxelin M, Korpela R. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001 Jun 2;322(7298):1327. doi: 10.1136/bmj.322.7298.1327.

Reference Type BACKGROUND
PMID: 11387176 (View on PubMed)

Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993 Mar;94(3):281-8. doi: 10.1016/0002-9343(93)90060-3.

Reference Type BACKGROUND
PMID: 8452152 (View on PubMed)

Holzapfel WH, Haberer P, Geisen R, Bjorkroth J, Schillinger U. Taxonomy and important features of probiotic microorganisms in food and nutrition. Am J Clin Nutr. 2001 Feb;73(2 Suppl):365S-373S. doi: 10.1093/ajcn/73.2.365s.

Reference Type BACKGROUND
PMID: 11157343 (View on PubMed)

Isolauri E. Probiotics in human disease. Am J Clin Nutr. 2001 Jun;73(6):1142S-1146S. doi: 10.1093/ajcn/73.6.1142S.

Reference Type BACKGROUND
PMID: 11393192 (View on PubMed)

Johanson WG, Pierce AK, Sanford JP. Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli. N Engl J Med. 1969 Nov 20;281(21):1137-40. doi: 10.1056/NEJM196911202812101. No abstract available.

Reference Type BACKGROUND
PMID: 4899868 (View on PubMed)

Johanson WG Jr, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med. 1972 Nov;77(5):701-6. doi: 10.7326/0003-4819-77-5-701. No abstract available.

Reference Type BACKGROUND
PMID: 5081492 (View on PubMed)

Johanson WG Jr, Seidenfeld JJ, de los Santos R, Coalson JJ, Gomez P. Prevention of nosocomial pneumonia using topical and parenteral antimicrobial agents. Am Rev Respir Dis. 1988 Feb;137(2):265-72. doi: 10.1164/ajrccm/137.2.265.

Reference Type BACKGROUND
PMID: 3341620 (View on PubMed)

Rayes N, Seehofer D, Hansen S, Boucsein K, Muller AR, Serke S, Bengmark S, Neuhaus P. Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation. 2002 Jul 15;74(1):123-7. doi: 10.1097/00007890-200207150-00021.

Reference Type BACKGROUND
PMID: 12134110 (View on PubMed)

Saavedra JM. Clinical applications of probiotic agents. Am J Clin Nutr. 2001 Jun;73(6):1147S-1151S. doi: 10.1093/ajcn/73.6.1147S.

Reference Type BACKGROUND
PMID: 11393193 (View on PubMed)

Vanderhoof JA. Probiotics: future directions. Am J Clin Nutr. 2001 Jun;73(6):1152S-1155S. doi: 10.1093/ajcn/73.6.1152S.

Reference Type BACKGROUND
PMID: 11393194 (View on PubMed)

Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010 Oct 15;182(8):1058-64. doi: 10.1164/rccm.200912-1853OC. Epub 2010 Jun 3.

Reference Type DERIVED
PMID: 20522788 (View on PubMed)

Other Identifiers

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03-13013

Identifier Type: -

Identifier Source: org_study_id

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