ABSTRACT
Intravenous immunoglobulin (IVIG) is widely used as prophylaxis against severe infections in intensive-care unit patients and as an adjunctive measure of sepsis treatment, especially in patients with severe sepsis and septic shock. When doing this, we intensivists, however, must bear in mind that this approach does not belong to the currently approved medical indications for IVIG products1. (Note that this chapter focuses on IVIG application in adult intensive-care unit patients. Sources for IVIG prophylaxis and treatment in neonates can be found in reference 2.)
RATIONALE
Low immunoglobulin G (IgG) and IgM levels predispose to postoperative infections. In patients with sepsis, serum immunoglobulin levels are often found to be in the lower normal range. Intravenous immunoglobulin therapy aims at raising the serum levels for at least several days to the upper normal range or even above. In adult patients this has been achieved, for instance, in the case of an IVIG(G) preparation by a total of 0.9g/kg body weight (0.6g/kg on day 1 and 0.3g/kg on day 2), and in the case of an IVIG(GMA) preparation (5% solution with 3.8g IgG, 0.6g IgM and 0.6g IgA per 100ml) with a total of 0.75g/kg (0.25g/kg=5ml/kg each on 3 consecutive days)3. Many mechanisms have been discussed as the basis for a beneficial role of IVIG in sepsis2, with complement inhibition being one of the recent findings4.
