Use of intravenous immune globulin in the ICU: a retrospective review of prescribing practices and patient outcomes.
BACKGROUND
Intravenous immune globulin (IVIG) is a pooled human blood product. Much of IVIG use in Canada is prescribed for 'unlabelled' or 'off-label' indications. Due to costs, risk of use and limited supply, knowledge about the use of IVIG is important. We collected data regarding the usage of IVIG and outcomes of patients receiving IVIG in the intensive care units (ICUs) of two community and three academic hospitals.


METHODS
We reviewed the charts of adult patients who received IVIG in the five ICUs over a 5-year period. Data collection included demographics, severity of illness, indication for and dose of IVIG, mortality and adverse effects. On the basis of a classification developed by Canadian Blood Services, the indications for IVIG were then classified as 'appropriate' or 'inappropriate'.


RESULTS
One hundred and forty-five patients received IVIG in the ICU. In all, 19% of IVIG prescriptions were for 'appropriate' indications and 7% were 'inappropriate'. The remaining 74% were prescribed for indications with some evidence to support their use. Three indications accounted for 50% of all IVIG prescribed: Guillain-Barre syndrome (GBS), necrotising fasciitis (NF) and toxic epidermal necrolysis (TEN). Both the community and academic centres prescribed IVIG for similar indications. Adverse effects associated with IVIG administration included deep vein thrombosis/pulmonary embolism, fever and renal failure, although direct causation related to IVIG could not be established. The overall mortality rate was 55%.


CONCLUSIONS
IVIG is used relatively infrequently in the critical care setting. The most common indications were GBS, TEN and NF. Mortality was high. There was no difference between community and academic ICUs.
Foster
R
R
Department of Medicine, Kelowna General Hospital, University of British Columbia Southern Medical Program, Kelowna, British Columbia, Canada.
Suri
A
A
Filate
W
W
Hallett
D
D
Meyer
J
J
Ruijs
T
T
Callum
J L
JL
Sutton
D
D
Mehta
S
S
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D058186:Acute Kidney Injury / Q000209:etiology; D003422:Critical Care / Q000706:statistics & numerical data*; D019115:Fasciitis, Necrotizing / Q000628:therapy; D005334:Fever / Q000209:etiology; D020275:Guillain-Barre Syndrome / Q000628:therapy; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000628:therapy; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous