Skip to main content
Top
Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

Xuebijing injection in the treatment of severe pneumonia: study protocol for a randomized controlled trial

Authors: Ping Wang, Yuanlin Song, Zhi Liu, Hui Wang, Wenke Zheng, Si Liu, Zhiqiao Feng, Jingbo Zhai, Chen Yao, Ming Ren, Chunxue Bai, Hongcai Shang

Published in: Trials | Issue 1/2016

Login to get access

Abstract

Background

Severe pneumonia (SP) is a major complication of respiratory system diseases that is associated with high mortality and morbidity. If not treated correctly, it may rapidly lead to sepsis and multiple organ dysfunction syndrome. Despite continuous developments in antibiotic treatments for SP, the mortality rate remains high. Both basic and clinical research show that Xuebijing injection (XBJ) can improve the symptoms of SP. The aim of this study is to evaluate the effectiveness and safety of XBJ compared with placebo.

Methods/design

This multicenter, blinded, randomized controlled trial will be conducted with a total of 700 participants with SP. Using a central randomization system, participants will be randomized (1:1) into groups receiving either XBJ or placebo (within 24 h of diagnosis of SP) for 5–7 days with a 28-day follow-up. All participants will receive conventional treatment simultaneously. Both XBJ and placebo will be administered using a photophobic infusion set to avoid bias. The primary outcome is improvement of Pneumonia Severity Index risk rate. Adverse events will be monitored throughout the trial.

Discussion

This is the first and largest randomized trial done in China on SP treatment using a Chinese herbal extract. In this trial, we will use central randomization and an electronic case report form, and we have designed an innovative blinding method for the traditional Chinese medicine injection. The results of this trial may help to provide evidence-based recommendations to clinicians for treatment of SP.

Trial registration

Chinese Clinical Trials Registry ChiCTR-TRC-13003534. Registered 24 June 2013.
Literature
1.
go back to reference Sirvent JM, de la Torre MC, Lorencio C, Taché A, Ferri C, Garcia-Gil J, et al. Predictive factors of mortality in severe community-acquired pneumonia: a model with data on the first 24 h of ICU admission. Med Intensiva. 2013;37:308–15.CrossRefPubMed Sirvent JM, de la Torre MC, Lorencio C, Taché A, Ferri C, Garcia-Gil J, et al. Predictive factors of mortality in severe community-acquired pneumonia: a model with data on the first 24 h of ICU admission. Med Intensiva. 2013;37:308–15.CrossRefPubMed
2.
go back to reference Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH, Lefkowitz L, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am J Public Health. 2000;90:223–9.CrossRefPubMedPubMedCentral Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH, Lefkowitz L, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am J Public Health. 2000;90:223–9.CrossRefPubMedPubMedCentral
3.
go back to reference Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–54.CrossRefPubMed Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–54.CrossRefPubMed
4.
go back to reference Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest. 2008;133:610–7.CrossRefPubMed Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest. 2008;133:610–7.CrossRefPubMed
6.
go back to reference Hagiwara S, Iwasaka H, Hasegawa A, Hidaka S, Uno A, Ueo K, et al. Filtration leukocytapheresis therapy ameliorates lipopolysaccharide-induced systemic inflammation in a rat model. J Surg Res. 2011;171:777–82.CrossRefPubMed Hagiwara S, Iwasaka H, Hasegawa A, Hidaka S, Uno A, Ueo K, et al. Filtration leukocytapheresis therapy ameliorates lipopolysaccharide-induced systemic inflammation in a rat model. J Surg Res. 2011;171:777–82.CrossRefPubMed
7.
go back to reference Matsuse H, Yanagihara K, Mukae H, Tanaka K, Nakazato M, Kohno S. Association of plasma neutrophil elastase levels with other inflammatory mediators and clinical features in adult patients with moderate and severe pneumonia. Respir Med. 2007;101:1521–8.CrossRefPubMed Matsuse H, Yanagihara K, Mukae H, Tanaka K, Nakazato M, Kohno S. Association of plasma neutrophil elastase levels with other inflammatory mediators and clinical features in adult patients with moderate and severe pneumonia. Respir Med. 2007;101:1521–8.CrossRefPubMed
8.
go back to reference Levi M, van der Poll T, Schultz M. New insights into pathways that determine the link between infection and thrombosis. Neth J Med. 2012;70:114–20.PubMed Levi M, van der Poll T, Schultz M. New insights into pathways that determine the link between infection and thrombosis. Neth J Med. 2012;70:114–20.PubMed
9.
go back to reference De Pascale G, Bello G, Tumbarello M, Antonelli M. Severe pneumonia in intensive care: cause, diagnosis, treatment and management: a review of the literature. Curr Opin Pulm Med. 2012;18:213–21.CrossRefPubMed De Pascale G, Bello G, Tumbarello M, Antonelli M. Severe pneumonia in intensive care: cause, diagnosis, treatment and management: a review of the literature. Curr Opin Pulm Med. 2012;18:213–21.CrossRefPubMed
11.
go back to reference Ulloa L, Tracey KJ. The “cytokine profile”: a code for sepsis. Trends Mol Med. 2005;11:56–63.CrossRefPubMed Ulloa L, Tracey KJ. The “cytokine profile”: a code for sepsis. Trends Mol Med. 2005;11:56–63.CrossRefPubMed
12.
go back to reference Torres-Rosas R, Yehia G, Peña G, Mishra P, del Rocio T-BM, Moreno-Eutimio MA, et al. Dopamine mediates the vagal modulation of the immune system by electroacupuncture. Nat Med. 2014;20:291–5.CrossRefPubMedPubMedCentral Torres-Rosas R, Yehia G, Peña G, Mishra P, del Rocio T-BM, Moreno-Eutimio MA, et al. Dopamine mediates the vagal modulation of the immune system by electroacupuncture. Nat Med. 2014;20:291–5.CrossRefPubMedPubMedCentral
13.
go back to reference Wang Y, Ji M, Wang L, Chen L, Li J. Xuebijing injection improves the respiratory function in rabbits with oleic acid-induced acute lung injury by inhibiting IL-6 expression and promoting IL-10 expression at the protein and mRNA levels. Exp Ther Med. 2014;8:1593–8.PubMedPubMedCentral Wang Y, Ji M, Wang L, Chen L, Li J. Xuebijing injection improves the respiratory function in rabbits with oleic acid-induced acute lung injury by inhibiting IL-6 expression and promoting IL-10 expression at the protein and mRNA levels. Exp Ther Med. 2014;8:1593–8.PubMedPubMedCentral
14.
go back to reference Wang J. Integrative treatment of acute critical illness diagnosis and treatment ideas and practice course. Tianjin J Tradit Chin Med. 1998;15:241–2. Wang J. Integrative treatment of acute critical illness diagnosis and treatment ideas and practice course. Tianjin J Tradit Chin Med. 1998;15:241–2.
15.
go back to reference Xue L. Research of the new strategy for the treatment of systemic inflammatory response syndrome and multiple organ dysfunction syndrome: an experimental study of the effect of traditional Chinese herb “xue bi jing.”. Chin Crit Care Med. 1997;9:18–20. 64. Xue L. Research of the new strategy for the treatment of systemic inflammatory response syndrome and multiple organ dysfunction syndrome: an experimental study of the effect of traditional Chinese herb “xue bi jing.”. Chin Crit Care Med. 1997;9:18–20. 64.
16.
go back to reference Jiao L, Yao Y, Shou S. Effects of Xuebijing injection on hepatic gelsolin and inflammatory cytokine in septic rats. Med J Chin Peoples Liberation Army. 2011;36:14–6. Jiao L, Yao Y, Shou S. Effects of Xuebijing injection on hepatic gelsolin and inflammatory cytokine in septic rats. Med J Chin Peoples Liberation Army. 2011;36:14–6.
17.
go back to reference He XD, Wang Y, Wu Q, Wang HX, Chen ZD, Zheng RS, et al. Xuebijing protects rats from sepsis challenged with Acinetobacter baumannii by promoting annexin A1 expression and inhibiting proinflammatory cytokines secretion. Evid Based Complement Alternat Med. 2013;2013:804940. doi:10.1155/2013/804940.PubMedPubMedCentral He XD, Wang Y, Wu Q, Wang HX, Chen ZD, Zheng RS, et al. Xuebijing protects rats from sepsis challenged with Acinetobacter baumannii by promoting annexin A1 expression and inhibiting proinflammatory cytokines secretion. Evid Based Complement Alternat Med. 2013;2013:804940. doi:10.​1155/​2013/​804940.PubMedPubMedCentral
18.
go back to reference Geng P, Xia P, Gu J, Xu M, Xu J, Tan D, et al. Intervention of Xuebijing injection against early hypercoagulability in patients with severe sepsis. Chin J Integr Tradit West Med Intensive Crit Care. 2008;15:346–9. Geng P, Xia P, Gu J, Xu M, Xu J, Tan D, et al. Intervention of Xuebijing injection against early hypercoagulability in patients with severe sepsis. Chin J Integr Tradit West Med Intensive Crit Care. 2008;15:346–9.
19.
go back to reference Dai XG, Yao YM, Ai YH, Yu Y. The enhancing effect of “Xuebijing injection” on lipopolysaccharide-induced apoptosis of regulatory T cells and mediation of polarization of helper T cells [in Chinese]. Zhonghua Shao Shang Za Zhi. 2009;25:106–10.PubMed Dai XG, Yao YM, Ai YH, Yu Y. The enhancing effect of “Xuebijing injection” on lipopolysaccharide-induced apoptosis of regulatory T cells and mediation of polarization of helper T cells [in Chinese]. Zhonghua Shao Shang Za Zhi. 2009;25:106–10.PubMed
20.
go back to reference Zhu MJ, Zhang G, Hu MH, Chen YB, Ji CL. Stasis-resolving and detoxifying effect of Xuebijing injection on severe pneumonia: a systematic review. Chin J Evid Based Med. 2014;14:462–8. Zhu MJ, Zhang G, Hu MH, Chen YB, Ji CL. Stasis-resolving and detoxifying effect of Xuebijing injection on severe pneumonia: a systematic review. Chin J Evid Based Med. 2014;14:462–8.
21.
go back to reference Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.CrossRefPubMed Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.CrossRefPubMed
22.
go back to reference Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644–55.CrossRefPubMed Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644–55.CrossRefPubMed
23.
go back to reference The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33. The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.
24.
go back to reference Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMed Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMed
25.
go back to reference Julián-Jiménez A, Reyes MJ P de l, Parejo Miguez R, Laín-Terés N, Cuena-Boy R, Lozano-Ancín A. Improved management of community-acquired pneumonia in the emergency department. Arch Bronconeumol. 2013;49:230–40.CrossRefPubMed Julián-Jiménez A, Reyes MJ P de l, Parejo Miguez R, Laín-Terés N, Cuena-Boy R, Lozano-Ancín A. Improved management of community-acquired pneumonia in the emergency department. Arch Bronconeumol. 2013;49:230–40.CrossRefPubMed
26.
go back to reference Li J, Qiao Y, Zhang H, et al. The therapeutic effects of Xuebijing injection on community acquired pneumonia patients accompanied by acute kidney injury. Chin J Integr Tradit West Med Intensive Crit Care. 2012;19(4):226–9. Li J, Qiao Y, Zhang H, et al. The therapeutic effects of Xuebijing injection on community acquired pneumonia patients accompanied by acute kidney injury. Chin J Integr Tradit West Med Intensive Crit Care. 2012;19(4):226–9.
27.
go back to reference Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005;26:1138–80.CrossRefPubMed Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005;26:1138–80.CrossRefPubMed
28.
go back to reference Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology. 2009;50:2022–33.CrossRefPubMed Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology. 2009;50:2022–33.CrossRefPubMed
29.
go back to reference Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138:720–3.CrossRefPubMed Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138:720–3.CrossRefPubMed
30.
go back to reference Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.CrossRefPubMed Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.CrossRefPubMed
31.
go back to reference Middleton PM. Practical use of the Glasgow Coma Scale: a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15:170–83.CrossRefPubMed Middleton PM. Practical use of the Glasgow Coma Scale: a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15:170–83.CrossRefPubMed
32.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed
33.
go back to reference Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–8.CrossRefPubMed Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–8.CrossRefPubMed
35.
go back to reference Shang HC, Zhang JH, Dai GH, Cao HB, Ren M, Xiang YZ, et al. Administration and quality control of large-scale clinical trials of traditional Chinese medicine [in Chinese]. Zhong Xi Yi Jie He Xue Bao. 2007;5:1–4.CrossRefPubMed Shang HC, Zhang JH, Dai GH, Cao HB, Ren M, Xiang YZ, et al. Administration and quality control of large-scale clinical trials of traditional Chinese medicine [in Chinese]. Zhong Xi Yi Jie He Xue Bao. 2007;5:1–4.CrossRefPubMed
36.
go back to reference Song Y, Song Z, Jiang J, Bai C. Clinical efficacy and safety evaluation of Xuebijing on severe pneumonia. Int J Respir. 2012;32(22):1692–5. Song Y, Song Z, Jiang J, Bai C. Clinical efficacy and safety evaluation of Xuebijing on severe pneumonia. Int J Respir. 2012;32(22):1692–5.
37.
go back to reference Food S, Administration D. National Drug Standards (amendment) promulgated pieces. Drug Stand China. 2013;14:448–73. Food S, Administration D. National Drug Standards (amendment) promulgated pieces. Drug Stand China. 2013;14:448–73.
38.
go back to reference Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H, et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis. 2007;44:41–9.CrossRefPubMed Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H, et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis. 2007;44:41–9.CrossRefPubMed
39.
go back to reference Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.CrossRefPubMed Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.CrossRefPubMed
40.
go back to reference Marras TK, Gutierrez C, Chan CK. Applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest. 2000;118:1339–43.CrossRefPubMed Marras TK, Gutierrez C, Chan CK. Applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest. 2000;118:1339–43.CrossRefPubMed
41.
go back to reference Arnold FW, Ramirez JA, McDonald LC, Xia EL. Hospitalization for community-acquired pneumonia: the pneumonia severity index vs clinical judgment. Chest. 2003;124:121–4.CrossRefPubMed Arnold FW, Ramirez JA, McDonald LC, Xia EL. Hospitalization for community-acquired pneumonia: the pneumonia severity index vs clinical judgment. Chest. 2003;124:121–4.CrossRefPubMed
42.
go back to reference Hu J, Shang H, Li J, Zhang J, Zhang L, Zhang B. Xuebijing injection for sepsis: a comprehensive review. Med J Chin Peoples Liberation Army. 2010;35:9–12. Hu J, Shang H, Li J, Zhang J, Zhang L, Zhang B. Xuebijing injection for sepsis: a comprehensive review. Med J Chin Peoples Liberation Army. 2010;35:9–12.
43.
go back to reference Xie F, Huang Q. Literature analysis of adverse reactions of Xuebijing injection [in Chinese]. Strait Pharm J. 2013;1:283–4. Xie F, Huang Q. Literature analysis of adverse reactions of Xuebijing injection [in Chinese]. Strait Pharm J. 2013;1:283–4.
Metadata
Title
Xuebijing injection in the treatment of severe pneumonia: study protocol for a randomized controlled trial
Authors
Ping Wang
Yuanlin Song
Zhi Liu
Hui Wang
Wenke Zheng
Si Liu
Zhiqiao Feng
Jingbo Zhai
Chen Yao
Ming Ren
Chunxue Bai
Hongcai Shang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1282-8

Other articles of this Issue 1/2016

Trials 1/2016 Go to the issue