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Early use of immunoglobulin in septic shock

Introduction

In addition to the interventions suggested by the guidelines of the Surviving Sepsis Campaign, in the recent years other therapeutic options have been proposed and tested for patients with severe sepsis and septic shock. Polyclonal intravenous immunoglobulins seem to be an interesting and useful option because of its activity in neutralizing endotoxin and in modulating the host immune response. In this retrospective study we assessed the effects of the early use of polyclonal intravenous immunoglobulins enriched with IgA-M (IgGAM) in addition to standard therapies on clinical outcome of patients with septic shock.

Methods

In January 2008, IgGAM was introduced into our ICU protocol for the management of septic shock patients (within 24 hours after shock appearance and at the dosage of 5 ml/kg for 3 days). From January 2008 to September 2009, we studied 52 consecutive patients with septic shock admitted to our ICU. In each patient we recorded the SAPS II and SOFA scores, the compliance to the 6-hour and the 24-hour sepsis bundles, the compliance to IgGAM use, the length of stay in the ICU and the 30-day mortality rate.

Results

Due to low compliance of medical staff to protocol application, IgGAM has been used only in 27 patients (IgGAM group). At ICU admission, the severity scores were similar in patients with and without (Control group) IgGAM therapy (SAPS II: control 54 (22 to 99), IgGAM: 59 (39 to 101); P > 0.05 and SOFA: control 9 (2 to 17); IgGAM 9 (4 to 15); P > 0.05). The compliance to 6-hour and 24-hour bundles was also similar in the two groups, apart from compliance to fluid therapy that was larger in the IgGAM group (85% vs 56% in Control group). The length of stay in the ICU was 15 ± 9 days in the IgGAM group and 18 ± 31 days in the Control group (P > 0.05); the 30-day mortality was lower (P < 0.05) in the IgGAM group (25%) than in the Control group (52%).

Conclusions

These preliminary data indicate that the early use of IgGAM, associated with interventions proposed by the SSC guidelines, reduces mortality of patients with septic shock.

References

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    Ballow M: Mechanism of action of intravenous immune serum globulin in autoimmune and inflammatory diseases. J Allergy Clin Immunol 1997, 100: 151-157. 10.1016/S0091-6749(97)70217-3

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    Werdan K: Mirror, mirror on the wall, which is the fairest meta-analysis of all? Crit Care Med 2007, 35: 2852-2854. 10.1097/01.CCM.0000297164.40980.F0

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Author information

Correspondence to IC Cavazzuti.

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Cite this article

Cavazzuti, I., Rinaldi, L., Donno, L. et al. Early use of immunoglobulin in septic shock. Crit Care 14, P25 (2010). https://doi.org/10.1186/cc8257

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Keywords

  • Septic Shock
  • Severe Sepsis
  • Medical Staff
  • Host Immune Response
  • Fluid Therapy