Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients

This open-label, randomized trial (CONFIDENT trial) studied 475 mechanically ventilated adults with Covid-19–induced ARDS across 17 Belgian ICUs, comparing high-titer convalescent plasma (≥1:320 NT50, accepted ≥1:160 during shortages) vs. standard care. Primary outcome:

Mortality at day 28:

Convalescent plasma: 35.4%

Standard care: 45.0% (P=0.03) Benefit was strongest when plasma was given within 48 hours of ventilation initiation. Plasma donors recovered 28 days to 10 months prior; neutralization was lab-confirmed (Nextstrain clade 20B strain). Nearly all patients received glucocorticoids. Serious adverse events: Comparable across groups, with no events directly attributed to plasma. Subgroup analysis showed amplified effect with higher SOFA scores; antibody titers rose post-infusion. Authors conclude early passive immunization with potent convalescent plasma reduces 28-day mortality in ventilated ARDS patients.

This open-label, randomized trial (CONFIDENT trial) studied 475 mechanically ventilated adults with Covid-19–induced ARDS across 17 Belgian ICUs, comparing high-titer convalescent plasma (≥1:320 NT50, accepted ≥1:160 during shortages) vs. standard care. Primary outcome:

Mortality at day 28:

Convalescent plasma: 35.4%

Standard care: 45.0% (P=0.03) Benefit was strongest when plasma was given within 48 hours of ventilation initiation. Plasma donors recovered 28 days to 10 months prior; neutralization was lab-confirmed (Nextstrain clade 20B strain). Nearly all patients received glucocorticoids. Serious adverse events: Comparable across groups, with no events directly attributed to plasma. Subgroup analysis showed amplified effect with higher SOFA scores; antibody titers rose post-infusion. Authors conclude early passive immunization with potent convalescent plasma reduces 28-day mortality in ventilated ARDS patients.