Concept for a study design in patients with severe community-acquired pneumonia: A randomised controlled trial with a novel IGM-enriched immunoglobulin preparation – The CIGMA study

Welte, Tobias; Dellinger, R Phillip; Ebelt, Henning; Ferrer, Miquel; Opal, Steven M.; Schliephake, Dorothee; Wartenberg-Demand, Andrea; Werdan, Karl; Löffler, Kurt; Torres, Antoni

doi:10.1016/j.rmed.2015.03.008

Cited by 37 publications

(25 citation statements)

References 47 publications

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“…However, these studies investigated CAP in general, not pneumococcal pneumonia specifically. Studies focusing on the acute treatment of pneumococcal pneumonia with corticosteroids or other immunomodulators [48] are therefore needed. Unfortunately, we have no systematic data on the number of patients who received pneumococcal conjugate vaccine-13 or pneumococcal polysaccharide vaccine-23.…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

et al. 2018

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Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively. was the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.

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Section: Discussionmentioning

confidence: 99%

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

et al. 2018

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“…In addition to steroids, novel therapeutic agents being studied include compounds that neutralize toxins, including pneumolysin, 161 monoclonal or polyclonal antibodies to specific pathogens, 162 163 and immunoglobulin therapy. 164 Most deaths directly attributable to CAP involve either septic shock or severe hypoxemic respiratory failure in patients with either viruses or antibiotic susceptible bacteria; improvement in ICU support technologies are therefore a different but very valid strategy to improve outcomes of CAP. Gas exchange support while avoiding injurious ventilator strategies via extracorporeal carbon dioxide removal and a new generation of extracorporeal membrane oxygenators are being studied.…”

Section: Emerging Treatmentsmentioning

confidence: 99%

Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

159

112

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Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences.

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“…The current strategy is to test and to use IVIG in more homogenous cohorts of patients. One example is the study on IVIG administration for patients with community acquired pneumonia, which is being prepared (Welte et al 2015).…”

Section: Intravenous Immunoglobulinsmentioning

confidence: 99%

Immunotherapy of Sepsis: Blind Alley or Call for Personalized Assessment?

Průcha

Zazula

Rußwurm

2016

Arch. Immunol. Ther. Exp.

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Sepsis is the most frequent cause of death in noncoronary intensive care units. In the past 10 years, progress has been made in the early identification of septic patients and their treatment. These improvements in support and therapy mean that mortality is gradually decreasing, however, the rate of death from sepsis remains unacceptably high. Immunotherapy is not currently part of the routine treatment of sepsis. Despite experimental successes, the administration of agents to block the effect of sepsis mediators failed to show evidence for improved outcome in a multitude of clinical trials. The following survey summarizes the current knowledge and results of clinical trials on the immunotherapy of sepsis and describes the limitations of our knowledge of the pathogenesis of sepsis. Administration of immunomodulatory drugs should be linked to the current immune status assessed by both clinical and molecular patterns. Thus, a careful daily review of the patient's immune status needs to be introduced into routine clinical practice giving the opportunity for effective and tailored use of immunomodulatory therapy.

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Concept for a study design in patients with severe community-acquired pneumonia: A randomised controlled trial with a novel IGM-enriched immunoglobulin preparation – The CIGMA study

Abstract: EUDRACT 2010-022380-35.

Cited by 37 publications

References 47 publications

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia

Advances in the causes and management of community acquired pneumonia in adults

Immunotherapy of Sepsis: Blind Alley or Call for Personalized Assessment?

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