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Intravenous immunoglobulin for adjunctive treatment of severe infections in ICUs

Aubron, Cécilea,b; Berteau, Floriana; Sparrow, Rosemary L.c

Current Opinion in Critical Care: October 2019 - Volume 25 - Issue 5 - p 417–422
doi: 10.1097/MCC.0000000000000639
SEVERE INFECTIONS: Edited by Michael S. Niederman
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Purpose of review This review focuses on the emerging literature regarding the use of intravenous immunoglobulins (IVIg) in critically ill patients with severe infections. The aim is to provide an accessible summary of the most recent evidence of IVIg use in sepsis and septic shock and to help clinicians to understand why there is still equipoise regarding the potential benefit of this adjunctive therapy in this setting.

Recent findings Observational studies with propensity score matching analyses and investigating the effect of IVIg in severe infections including necrotizing soft tissue infection have been recently published. These studies suffer important flaws precluding robust conclusion to be drawn. Some recent randomized controlled trials raised interesting findings supportive of personalized medicine but are likely to be underpowered or confounded.

Summary Insufficient evidence is available to support IVIg use in sepsis and septic shock, apart from the specific case of streptococcal toxic shock syndrome. Current literature suggests that IVIg efficacy in sepsis or septic shock could depend on the IVIg preparation (IgM-enriched or minimal IgM), time of administration (<24 h), dose, and the inflammatory/immunomodulation profile of the patients. Investigator-initiated research, incorporating these parameters, is warranted to determine whether IVIg benefits critically ill patients with severe infection.

aDepartement de Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Université de Bretagne Occidentale, Brest, France

bDepartment of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC)

cDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

Correspondence to Cécile Aubron, MD, Ph.D., Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Bvd Tanguy Prigent, 29609 Brest Cedex, France. Tel: +61 2 98 34 71 81; fax: +61 2 98 34 79 65; e-mail: cecile.aubron@chu-brest.fr,cecile.aubron@monash.edu

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