title: Intravenous immunoglobulin in critically ill adults: When and what is the evidence?
abstract: Intravenous immunoglobulin (IVIg) use is growing dramatically internationally due to the increasing numbers of acute and chronic conditions that may benefit from IVIg. Patients with conditions that may benefit from IVIg might require intensive care unit (ICU) admission, supporting the need to review IVIg use in the critical care setting. The most common clinical indications for IVIg in adults that may require ICU admission and are commonly supported under clinical practice guidelines are Guillain-Barré syndrome, myasthenia gravis and Lambert-Eaton myasthenic syndrome, inflammatory myopathies, and primary or secondary immunodeficiency diseases complicated by severe bacterial sepsis. Other emerging indications include necrotizing fasciitis, toxic epidermal necrolysis/Stevens-Johnson syndrome, and toxic shock syndrome. The evidence for IVIg use in sepsis and septic shock remains controversial and insufficient to recommend its routine use. Intravenous immunoglobulin is expensive and also carries risks of adverse effects, including common and benign infusion-related reactions, as well as relatively rare and more serious problems, such as thromboembolic events, renal failure, and aseptic meningitis. In this article, we review the literature on conditions requiring ICU admission and IVIg, and we classify them as supported, emerging, or unsupported indications based on the available evidence and guidelines for clinical use of IVIg.
authors.affiliation: ANZIC Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: ANZIC Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: Z K
authors.initials: ZK
authors.lastname: McQuilten
authors.affiliation: Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: E M
authors.initials: EM
authors.lastname: Wood
authors.affiliation: ANZIC Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Réanimation médicale, Hôpital Universitaire de Brest site de la Cavale Blanche, Université de Bretagne Occidentale, 29200 Brest, France. Electronic address: cecile.aubron@monash.edu.
authors.forename: C
authors.initials: C
authors.lastname: Aubron
mesh_terms: D016638:Critical Illness; D019115:Fasciitis, Necrotizing / Q000188:drug therapy*; D020275:Guillain-Barre Syndrome / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D009157:Myasthenia Gravis / Q000188:drug therapy*; D018805:Sepsis / Q000188:drug therapy*; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy*
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Critically ill patients; Intensive care unit (ICU); Intravenous immunoglobulin