Uso de probióticos em pacientes queimados: revisão sistemática

Abstract

OBJECTIVE: The purpose of this review was to evaluate the effectiveness of probiotics in acute burn patients, including the effect on wound healing time and length of hospital stay. METHODS: Randomized clinical trials (RCTs) that evaluated the effect of probiotics compared to placebo in patients with recent burns and wounds not yet closed, regardless of the magnitude or cause, were included. Healing time and length of hospital stay were the primary outcomes evaluated, development of infectious complications and adverse effects (diarrhea, constipation, flatulence, vomiting) were the secondary outcomes. Studies that used other interventions such as vitamins or supplements and studies in patients with wounds already healed were excluded. The search was performed in the following databases: Cochrane Library, LILACS/ BVS, PubMed, Embase, Scielo, OpenGrey, and Google Scholar. In addition, a manual search was performed in the references of selected articles. The Cochrane Collaboration Tool Risk of bias in randomized trials (RoB 2) was used in the risk of bias assessment. The quality of evidence was assessed according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: One thousand four hundred eleven studies were found by searching the databases and two from the manual search in the references of selected articles. Four hundred and forty-three duplicates were excluded, and 970 studies were screened based on title and abstract. After this process, 960 studies were excluded, and a full-text read was performed on the remaining ten studies for eligibility. After a full-text read, eight ere excluded, and two studies were selected for data extraction. In the study by El-Ghazely et al. 2016, the healing time decreased in the probiotic group, with a mean of 16.25 days (± 0.23) compared to the placebo group, with a mean of 20.7 days (± 0.51). The healing time decreased in the probiotic group with a mean of -4.45 days (-4.7 to -4.2) 95% CI. Mayes et al. 2015 evaluated the healing time/ total body surface area burn and had a mean of 0.83 (± 0.1) in the probiotic group compared to 1.02 (± 0.1) in the group control. Patients using probiotics had a difference between healing time/ total body surface area burn and decreased with a mean of -0.19 (-0.28 to -0.10) 95% CI. In the study by El-Ghazely et al. 2016, the length of hospital stay decreased in the probiotic group, with a mean of 17.25 days (± 0.49) compared to the control group, with a mean of 21.9 days (±2.17). The length of hospital stay decreased in the probiotic group with a mean of - 4.65 (-5.62 to -36.8) 95% CI. Mayes et al. 2015 evaluated the length of hospital stay/ total body surface area burn and had a mean of 1.04 (± 0.01) in the probiotic group, compared to 1.09 (± 0.2) in the control group. Patients using probiotics had a difference between hospital stay/ total body surface area burn with a mean of -0.05 (-0.17 to -0.07) 95% CI. CONCLUSION: The healing time and length of hospital stay decreased in the probiotic group in both studies analyzed, which from a clinical point of view represents a significant decrease in the risk of developing severe and other various complications leading to higher morbidity and mortality of burn patients. Moreover, when both outcomes decrease, they represent a significant reduction in hospitalization osts. Regarding the development of infectious diseases and adverse events, large clinical trials on efficacy and safety in larger groups are still needed to evaluate the effects of these outcomes better. This is a systematic literature review based on the Cochrane Collaboration methodology. The protocol of this systematic review was registered on the Open Science Framework Registration (OSF) platform at https://osf.io/dashboard, on November 11, 2020, under the code osf.io/7vnw3 and followed the Cochrane Collaboration methodology.