Caringbah

Researchers are evaluating a range of treatments to improve outcomes for adults admitted to intensive care units (ICUs) with severe community-acquired pneumonia (CAP), including cases caused by influenza and COVID-19. This Phase 3 adaptive platform trial, REMAP-CAP, is designed to test multiple treatment strategies simultaneously and adapt over time, allowing new treatments to be added as questions are answered. The trial also serves as a platform to quickly evaluate treatments during respiratory pandemics, such as COVID-19, through a sub-study called REMAP-COVID in the United States. Participants receive various interventions including antibiotics like ceftriaxone, moxifloxacin, or piperacillin-tazobactam, as well as macrolide therapies given for different durations. Other treatments assessed include corticosteroids such as hydrocortisone and dexamethasone, antiviral agents like oseltamivir and remdesivir, immune modulators including tocilizumab and baricitinib, and supportive care strategies such as mechanical ventilation methods. Dosing and duration vary for each treatment, with some interventions now closed. Treatments are administered according to local guidelines and clinical decisions, with some requiring intravenous or enteral routes. Participants are closely monitored with assessments focusing on survival and organ support status in the ICU up to 90 days after enrollment. The main outcomes measured include all-cause mortality by day 90 and the number of days alive without needing organ support in the ICU by day 21. The study collects data continuously to adapt treatment assignments for new participants, aiming to identify the most effective therapies. Follow-up and safety monitoring continue throughout hospitalization and up to 90 days after admission.

This research aims to provide detailed information on the long-term outcomes related to neuroprotection and recovery improvements for survivors of out-of-hospital cardiac arrest. It evaluates different targets for sedation, temperature, and blood pressure management in these patients, as well as the impact on caregivers who support them. The study is part of a larger international, multi-center randomized trial called STEPCARE. Participants who survived out-of-hospital cardiac arrest and were part of the STEPCARE trial will be followed at selected sites. They will have experienced various interventions such as deep or minimal sedation, different blood pressure targets using vasopressors, and fever management either with or without a feedback-controlled temperature device. These treatments are applied during the first 36 hours after cardiac arrest. The study involves follow-up assessments at 6 and 12 months after the cardiac arrest event. Survivors will be evaluated for cognitive function using the Montreal Cognitive Assessment, while caregivers will be assessed for burden using the Zarit Burden Interview. The study plans to enroll about 600 survivors along with one nominated caregiver per survivor to understand both patient outcomes and caregiver impact over time.