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The role of probiotics in the prevention of ventilator-associated pneumonia (VAP) remains inconclusive. The aim of this study was to assess the efficacy of a probiotic regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, patients expected to require mechanical ventilation for >10 days were assigned at random to receive prophylaxis with a probiotic formula (n= 59) or placebo (n= 53). The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 [1.75 x10(9) colony-forming units (cfu)], Lactobacillus plantarum (0.5 x10(9) cfu), Bifidobacterium lactis BB-12 (1.75 x109 cfu) and Saccharomyces boulardii (1.5 x10(9) cfu) in sachets. Each patient received two sachets twice daily for 15 days: one through the nasogastric tube and one spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis, and the duration of hospital stay were the secondary endpoints. Administration of probiotics reduced the incidence of VAP [11.9% vs 28.3%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.13-0.92; P=0.034] and sepsis [6.8% vs 24.5%, odds ratio 0.22, 95% CI 0.07-0.74: P= 0.016]. Furthermore, probiotic prophylaxis reduced the time of stay in the intensive care unit (ICU) and the length of hospital stay. The prophylactic use of probiotics with a combination of enteral and topical application to the oropharynx had a positive effect on the incidence of VAP and sepsis, as well as on ICU and total hospital stay in patients receiving protracted mechanical ventilation. (C) 2021 The Authors. Published by Elsevier Ltd.

Background: Unexpected failure events are undesired harmful effects, which result in prolonged hospital stay, higher mortality and morbidity rates and increased hospital costs. The aim of our study was to identify and thorough investigate patients hospitalized in our university surgical ward, who had to be transferred to the surgical ICU (SICU) due to such an event. Methods: This was a retrospective observational study performed in the surgical ward of a large, urban, teaching hospital during a 2.5 year period. All failure events, which resulted in the transport of surgical patients from ward to the SICU, were included and reviewed. Results: There were 56 failure events recorded in 43 patients. Most patients suffering a failure event were admitted through the Emergency Department as acute cases (55,81%) and in most cases the failure event was identified by a nurse on duty (51,8%). Respiratory failure was the most common final diagnosis after SICU admission (60,71%). Of the total 43 patients suffering one or more failure event, 14 died. Conclusions: Based on our results, it seems that high risk patients admitted through ED should be admitted into ICUs for safety reasons. Moreover, triggering systems and monitoring of postsurgical patients, especially respiratory monitoring, would be helpful in minimizing failure events.