?? Paper of the day
Prashant Nasa
ICU Physician - Co-editor: Rational use of IV Fluids in Critically ill (link in bio)- PROVE Network - Delphi Methodology - Fluid and Oxygen are Drugs - X: @drnasap
Published in #NEJM
Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients
Summary: This article discusses the CONFIDENT trial, which aimed to test the hypothesis that convalescent plasma with a neutralizing antibody titer of at least 1:320 would reduce mortality in patients with Covid-19-induced acute respiratory distress syndrome (ARDS) receiving invasive mechanical ventilation. The trial included adult patients in Belgium who had been admitted to the ICU with a diagnosis of COVID-19-induced ARDS and had received mechanical ventilation for up to 5 days.
The primary outcome of the trial was death by day 28 after randomization, and secondary outcomes included adverse events, inflammatory and anti-SARS-CoV-2 antibody responses, organ support, length of hospital stay, and death by day 90 and 365.
?? Takeaways:
1?? At day 28, mortality was 35.4% in the convalescent plasma group and 45.0% in the standard-care group (P=0.03).
2?? Effect was mainly in patients within 5 days (who underwent randomization 48 hours or less) after the initiation of invasive mechanical ventilation.
3?? Early institution of high-titre convalescent plasma in critical COVID-19 reduces mortality.
Limitations:
1. It is possible that convalescent plasma may still have some benefits in specific subgroups of patients or when administered at different stages of the disease.
2. The trial was conducted in Belgium, and the results may not be generalizable to other populations or healthcare settings. Further studies in different regions are needed to confirm the findings.