Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2023

Open Access 01-12-2023 | Respiratory Microbiota | Research

Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study

Authors: A. Cotoia, R. Paradiso, G. Ferrara, G. Borriello, F. Santoro, I. Spina, L. Mirabella, K. Mariano, G. Fusco, G. Cinnella, P. Singer

Published in: Critical Care | Issue 1/2023

Login to get access

Abstract

Background

Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP.

Methods

A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts.

Results

None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray–Curtis distance.

Conclusion

Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.
Literature
1.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.CrossRefPubMed
2.
McCarthy MS, Martindale RG. Immunonutrition in critical illness: what is the role? Nutr Clin Pract. 2018;33(3):348–58.CrossRefPubMed
3.
4.
Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, García-Fuentes C, Mor-Marco E, Bordeje-Laguna ML, et al. The effect of enteral immunonutrition in the intensive care unit: does it impact on outcomes? Nutrients. 2022;14(9):1904.CrossRefPubMedPubMedCentral
5.
Kaliannan K, Wang B, Li XY, Kim KJ, Kang JX. A host-microbiome interaction mediates the opposing effects of omega-6 and omega-3 fatty acids on metabolic endotoxemia. Sci Rep. 2015;11:5.
6.
Yuan B, Lu XJ, Wu Q. Gut microbiota and acute central nervous system injury: a new target for therapeutic intervention. Front Immunol. 2021;24(12):800796.CrossRef
7.
Zhang D, Li S, Wang N, Tan HY, Zhang Z, Feng Y. The cross-talk between gut microbiota and lungs in common lung diseases. Front Microbiol. 2020;25(11):301.CrossRef
8.
Wolff NS, Hugenholtz F, Wiersinga WJ. The emerging role of the microbiota in the ICU. Crit Care. 2018;22(1):1–7.CrossRef
9.
10.
Natalini JG, Singh S, Segal LN. The dynamic lung microbiome in health and disease. Nat Rev Microbiol. 2023;21(4):222–35.CrossRefPubMed
11.
12.
Powers KA, Dhamoon AS. Physiology pulmonary ventilation and perfusion. USA: Stat Pearls; 2022.
13.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.
14.
Cotoia A, Spadaro S, Gambetti G, Koulenti D, Cinnella G. Pathogenesis-targeted preventive strategies for multidrug resistant ventilator-associated pneumonia: a narrative review. Microorganisms. 2020;8(6):821.CrossRefPubMedPubMedCentral
15.
Hall M, Beiko RG. 16S rRNA gene analysis with QIIME2. In: methods in molecular biology. Humana Press Inc.; 2018. p. 113–29
16.
Callahan BJ, McMurdie PJ, Rosen MJ, Han AW, Johnson AJA, Holmes SP. DADA2: high-resolution sample inference from Illumina amplicon data. Nat Methods. 2016;13(7):581–3.CrossRefPubMedPubMedCentral
17.
Katoh K, Standley DM. MAFFT multiple sequence alignment software version 7: improvements in performance and usability. Mol Biol Evol. 2013;30(4):772–80.CrossRefPubMedPubMedCentral
18.
Price MN, Dehal PS, Arkin AP. Fasttree: computing large minimum evolution trees with profiles instead of a distance matrix. Mol Biol Evol. 2009;26(7):1641–50.CrossRefPubMedPubMedCentral
19.
DeSantis TZ, Hugenholtz P, Larsen N, Rojas M, Brodie EL, Keller K, et al. Greengenes, a chimera-checked 16S rRNA gene database and workbench compatible with ARB. Appl Environ Microbiol. 2006;72(7):5069–72.CrossRefPubMedPubMedCentral
20.
Bokulich NA, Kaehler BD, Rideout JR, Dillon M, Bolyen E, Knight R, et al. Optimizing taxonomic classification of marker-gene amplicon sequences with QIIME 2’s q2-feature-classifier plugin. Microbiome. 2018;6(1):1–7.CrossRef
21.
Knight R, Vrbanac A, Taylor BC, Aksenov A, Callewaert C, Debelius J, Gonzalez A, Kosciolek T, McCall LI, McDonald D, Melnik AV. Best practices for analysing microbiomes. Nat Rev Microbiol. 2018;16(7):410–22.CrossRefPubMed
22.
23.
Bokulich NA, Dillon MR, Zhang Y, Rideout JR, Bolyen E, Li H, Albert PS, Caporaso JG. q2-longitudinal: longitudinal and paired-sample analyses of microbiome data. MSystems. 2018;3(6):e00219-e318.CrossRefPubMedPubMedCentral
24.
Martino C, Morton JT, Marotz CA, Thompson LR, Tripathi A, Knight R, Zengler K. A novel sparse compositional technique reveals microbial perturbations. MSystems. 2019;4(1):e00016-19.CrossRefPubMedPubMedCentral
25.
Dickson RP, Schultz MJ, Van Der Poll T, Schouten LR, Falkowski NR, Luth JE, et al. Lung microbiota predict clinical outcomes in critically ill patients. Am J Respir Crit Care Med. 2020;201(5):555–63.CrossRefPubMedPubMedCentral
26.
Sommariva M, Le Noci V, Bianchi F, Camelliti S, Balsari A, Tagliabue E, Sfondrini L. The lung microbiota: role in maintaining pulmonary immune homeostasis and its implications in cancer development and therapy. Cell Mol Life Sci. 2020;77(14):2739–49.CrossRefPubMedPubMedCentral
27.
Dickson RP, Erb-Downward JR, Martinez FJ, Huffnagle GB. The Microbiome and the Respiratory Tract. Vol. 78, Annual Review of Physiology. Annual Reviews Inc.; 2016. p. 481–504
28.
Singer P, Calder PC. The role of omega-3 polyunsaturated fatty acids in the intensive care unit. Curr Opin Clin Nutr Metabolic Care. 2023;26(2):129–37.CrossRef
29.
Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med. 1999;27(12):2799–805.CrossRefPubMed
30.
Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients?: a systematic review of the evidence. JAMA. 2001;286(8):944–53.CrossRefPubMed
31.
Moron R, Galvez J, Colmenero M, Anderson P, Cabeza J, Rodriguez-Cabezas ME. The importance of the microbiome in critically ill patients: role of nutrition. Nutrients. 2019;11(12):3002.CrossRefPubMedPubMedCentral
32.
Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocrit Care. 2020;32(1):272–85.CrossRefPubMed
33.
Marra A, Vargas M, Buonanno P, Iacovazzo C, Coviello A, Servillo G. Early vs. late tracheostomy in patients with traumatic brain injury: systematic review and meta-analysis. J Clin Med. 2021;10(15):3319.
34.
Lamarche D, Johnstone J, Zytaruk N, Clarke F, Hand L, Loukov D, et al. Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study. Respir Res. 2018;19(1):1–2.CrossRef
35.
36.
Kelly BJ, Imai I, Bittinger K, Laughlin A, Fuchs BD, Bushman FD, et al. Composition and dynamics of the respiratory tract microbiome in intubated patients. Microbiome. 2016;4:7.
37.
Fenn D, Abdel-Aziz MI, van Oort PMP, Brinkman P, Ahmed WM, Felton T, et al. Composition and diversity analysis of the lung microbiome in patients with suspected ventilator-associated pneumonia. Crit Care. 2022;26(1):1–2.CrossRef
Metadata
Title
Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study
Authors
A. Cotoia
R. Paradiso
G. Ferrara
G. Borriello
F. Santoro
I. Spina
L. Mirabella
K. Mariano
G. Fusco
G. Cinnella
P. Singer
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2023
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-023-04531-5

Other articles of this Issue 1/2023

Critical Care 1/2023 Go to the issue

Research

Using automatic speckle tracking imaging to measure diaphragm excursion and predict the outcome of mechanical ventilation weaning

Review

Do critical illness survivors with multimorbidity need a different model of care?

Correspondence

The cephalic vein catheterization: maybe yes, but when there is no alternative

Research

Extracorporeal hemoadsorption in critically ill COVID-19 patients on VV ECMO: the CytoSorb therapy in COVID-19 (CTC) registry

Research

The association of hypoglycemia with outcome of critically ill children in relation to nutritional and blood glucose control strategies

Research

Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit