1. What are Probiotics? Commercially available microorganisms which, when ingested as individual strains or in combinations, offer potential health benefits to the host World Health Organization

3. Main PROSPECT Trial Research Question In the mechanically ventilated, critically ill patient, what is the effect of enteral L. rhamnosus GG when compared to placebo on… Ventilator Associated Pneumonia Other ICU-acquired infections Diarrhea (total, antibiotic associated and Clostridium difficile-associated diarrhea) Antibiotic use Duration of mechanical ventilation ICU and hospital length of stay ICU and hospital mortality

4. Inclusion Criteria –Adults ≥18 years –Admitted to ICU and invasively mechanically ventilated –Anticipated ventilation of ≥72 hours Exclusion Criteria –Invasively mechanically ventilated > 72 hours –Risk factors for iatrogenic infection Specific immunocompromized populations Patients at risk for endovascular infection Patients with a primary diagnosis of severe acute pancreatitis Patients with percutaneous gastric or jejunal feeding tubes already in situ –Strict contraindication or inability to receive enteral meds –Life support limitation –Previous enrolment in this or current enrolment in a potentially confounding trial

6. PROSPECT Administration Supplies Tap Water Catheter Tip Syringe (60ml) Specimen Container (80ml) Nasogastric Feeding Tube