Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23.

Adjunctive therapies Blood purification Checkpoint immune therapies Corticosteroids Immunoglobulins Sepsis Septic shock Specific immune therapies

Journal

Journal of anesthesia, analgesia and critical care
ISSN: 2731-3786
Titre abrégé: J Anesth Analg Crit Care
Pays: England
ID NLM: 9918591885906676

Informations de publication

Date de publication:
30 Apr 2024
Historique:
received: 28 01 2024
accepted: 18 04 2024
medline: 1 5 2024
pubmed: 1 5 2024
entrez: 30 4 2024
Statut: epublish

Résumé

In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies. A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method. The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions. Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.

Sections du résumé

BACKGROUND BACKGROUND
In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies.
METHODS METHODS
A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method.
RESULTS RESULTS
The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions.
CONCLUSIONS CONCLUSIONS
Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.

Identifiants

pubmed: 38689337
doi: 10.1186/s44158-024-00165-3
pii: 10.1186/s44158-024-00165-3
doi:

Types de publication

Journal Article

Langues

eng

Pagination

28

Informations de copyright

© 2024. The Author(s).

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Auteurs

Massimo Girardis (M)

Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy. girardis@unimore.it.

Irene Coloretti (I)

Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Massimo Antonelli (M)

Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Giorgio Berlot (G)

Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.

Stefano Busani (S)

Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Andrea Cortegiani (A)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.

Gennaro De Pascale (G)

Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Francesco Giuseppe De Rosa (FG)

Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, Italy.

Silvia De Rosa (S)

Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy.

Katia Donadello (K)

Department of Surgery, Dentistry, Ginaecology and Paediatrics, University of Verona, and Anesthesia and Intensive Care Unit B, University Hospital Integrated Trust of Verona, Verona, Italy.

Abele Donati (A)

Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.

Francesco Forfori (F)

Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Maddalena Giannella (M)

Department of Medical and Surgical Sciences Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Giacomo Grasselli (G)

Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Giorgia Montrucchio (G)

Department of Surgical Sciences, Departement of Anesthesia, Resuscitation and Emergency Torino, University of Turin, Turin, Italy.

Alessandra Oliva (A)

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Daniela Pasero (D)

Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.

Ornella Piazza (O)

University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy.

Stefano Romagnoli (S)

Department of Health Science, Department of Anesthesia and Intensive Care, University of Florence, Careggi University Hospital, Florence, Italy.

Carlo Tascini (C)

Department of Medicine (DAME), Infectious Diseases Clinic, University of Udine, Udine, Italy.

Bruno Viaggi (B)

Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.

Mario Tumbarello (M)

Infectious and Tropical Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

Pierluigi Viale (P)

Department of Medical and Surgical Sciences Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Classifications MeSH