Working group on Immuno-monitoring
Aims and Missions
This Working Group has been created because the format is unformal, allowing real exchanges between the participants. The topic covered by this group concerns all the techniques which are or will be used to assess the immunity in intensive care. Based on that, the first task of the Group is to focus on innate immunity monitoring-tests such as the monitoring of MHC class II molecule expression on blood monocytes. This HLA-DR measurement is better performed by flow cytometry, and requires standard protocols to enable the comparison towards centres.
Head
Didier Payen - Paris, France
Axel Nierhaus - Hamburg, Germany
Activities
Sepsis and SIRS have profound effects on the innate immunity. In the majority of patients surviving the first impact some degree of 'immuno-paralysis' will develop, which is characterized by low HLA- expression on monocytes and by a depressed ex vivo response of whole blood to LPS. This syndrome predisposes for acquiring nosocomial infections during the course of the ICU stay and is associated with increased mortality. However, the methodology for the assessment of clinically relevant parameters of the immune response yet has been neither sufficiently standardized nor validated. In the light of various novel therapeutic interventions aimed at modulating the immune response, the Research group on Immuno-monitoring believes that these should be based on data which are clinically and scientifically proven. 
During its third meeting in Amsterdam the Research group has finalised the study protocol for an international multi-centre observational study (E.M.S.I.C., European Multicentre Study of Immunomonitoring in Intensive Care). The study will focus on the clinical validation of a quantitative and standardized method (QuantiBrite®) to measure HLA- on peripheral monocytes in patients with severe sepsis and septic shock. A pre-trial interlab comparison with QuantiBrite® had been performed with satisfactory results concerning measurement variability across the participating centres. Apart from the usual clinical data, additional immunological parameters included in the protocol consist of IL-6, -10, LBP, PCT, GM-CSF and ex vivo stimulation of whole blood with LPS. By December 2003, the study protocol and all other relevant information can be accessed at www.emsic.net
Some years ago, the Group has performed a survey on the practice of inhaled NO. After the results of the main clinical trials in ALI/ARDS, the use of this treatment had probably changed.
However, such a therapy remains ordered as the consumption monitoring show, stimulating to precise why, how, and for what type of indication the anaesthesiologists and the intensivists continue to use inhaled NO. In addition, a group of European experts plan to write recommendations for the use of inhaled NO, which will be influenced largely by known practice in Europe.
A questionnaire has been sent to all ESICM members in order to evaluate the evolution of the practice of this treatment.
Meetings agenda and minutes
Useful Link
Section on Acute Respiratoty Failure |
