PROSPECT: Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial


We completed a pilot study in 14 ICUs in Canada and the United States which showed that a larger trial was feasible. Specifically, we enrolled the target number of patients, of which 40% were =65 years of age; we followed the protocol faithfully, made sure patients didn’t receive additional probiotics and estimated how many patients developed pneumonia.

We were then ready to establish the effects of probiotics in the ICU in a large trial. In critically ill patients who needed support by a breathing machine, we investigated whether oral L. rhamnosus GG (a common probiotic) prevented VAP and other infections. Following informed consent, patients were randomized to either L. rhamnosus GG group or an identical placebo twice daily, down a feeding tube. We recorded VAP, other serious infections such as Clostridium difficile and overutilization of antibiotics.

Dr. Deborah Cook, MD, FRCPC, MSc, CRC, CAHS, FRS practices critical care medicine at St. Joseph’s Healthcare Hamilton. At McMaster University, she is Professor of Medicine, Clinical Epidemiology & Biostatistics and Academic Chair of Critical Care. Her multi-method multi-disciplinary research interests include life support technology, risk factors for critical illness, prevention of ICU-acquired complications, end-of-life choices, and research ethics. Her methodological work has helped to improve the design, implementation and reporting of randomized trials and systematic reviews. As a Canada Research Chair in Knowledge Translation in Critical Care, and former Chair of the Canadian Critical Care Trials Group, Dr. Cook has published 500 peer-review articles and supervised many trainees and faculty. Dr. Cook has received numerous local, national and international awards for her clinical, educational and research excellence including Fellowship of the Royal Society.