The central role of the gut in intensive care

Table 1 Overview of the current preclinical and clinical trials with grade of evidence with potential application to the ICU

Interventions	Potential ICU applications	Grade of evidence
Nutritional approach (EN)	Promote GM eubiosis Reduce mortality/morbidity Reduce infectious complications	Very weak [113]
Adsorbent Charcoal	Prevention of RCDI	Very weak Pre clinical studies [114] One phase 2 trial completed[115]
Probiotics Prebiotics Synbiotics	Reduce infection rate, notably VAP	Weak [116,117,118] RCTs in ICU with low quality of evidence
	Coadjuvant in sepsis	Very weak [119, 120] Preclinical studies
	Coadjuvant in SARS-CoV-2 infection	Weak Ongoing RCTs in ICU [121,122,123,124,125,126]
	Coadjuvant in TBI	Very weak [127] Preclinical studies
	Prevention of RCDI	Very weak [128]
Beta-Lactamase	Prevention of RCDI	Very weak Phase 2 trials completed [129] One phase 1b/2a trial ongoing [130]
FMT	Treatment of RCDI	Weak [131, 132] One RCT [133] Four ICU retrospective cohort studies [134,135,136,137]
	Coadjuvant in TBI	Very weak [138] Pre clinical studies
	Coadjuvant in sepsis	Very weak [139, 140] Case reports and pre clinical studies

Evidence reported in ICU or critically ill settings have been specified
ICU intensive care unit, VAP ventilator associated pneumonia, TBI traumatic brain injury, RCDI recurrent clostridioides difficile infection, FMT fecal microbiota transplantation

ISSN: 1364-8535