POLYCLONAL INTRAVENOUS IMMUNE GLOBULIN FOR PREVENTION AND TREATMENT OF INFECTIONS IN CRITICALLY ILL PATIENTS

Infections remain the leading cause of death among patients admitted t o intensive care units (ICU). Infections due to Gram-negative bacteria are both frequent and difficult to treat. The poor outcome of such in fections has been attributed to the endotoxin. The high mortality rate related to Gram-negative sepsis has prompted the testing of new, adju nctive therapies to prevent and treat infections in critically ill pat ients. Immunotherapy or immunoprophylaxis have long been investigated in this context. Passive immunotherapy consists of the administration of immune plasma or serum, or standard or hyperimmune purified immune globulins. Several clinical studies using such preparations to treat c ritically ill patients are reviewed in this article. While two studies using hyperimmune plasma or serum appeared to be successful, two stud ies using hyperimmune globulin failed to show a beneficial effect in t he treatment or the prevention of Gram-negative septic shock. Regardin g the infusion of standard intravenous immune globulin (IVIG) two stud ies have demonstrated a substantial benefit in the prevention of sever e infections; the reduction of nosocomial pneumonia recorded in both t rials and the shortness of stay in ICU may also afford savings in hosp ital costs. The cost effectiveness of such prophylactic administration of IVIG is worthy of further investigation.