OBJECTIVE: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. METHODS: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. RESULTS: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n = 4), pneumothorax (n = 4) and electrolyte abnormalities and transfusion reactions (n = 10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. DISCUSSION: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.
OBJECTIVE: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. METHODS: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. RESULTS: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n = 4), pneumothorax (n = 4) and electrolyte abnormalities and transfusion reactions (n = 10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. DISCUSSION: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.
Authors: Nicholas L Zalewski; Alejandro A Rabinstein; Karl N Krecke; Robert D Brown; Eelco F M Wijdicks; Brian G Weinshenker; Timothy J Kaufmann; Jonathan M Morris; Allen J Aksamit; J D Bartleson; Giuseppe Lanzino; Melissa M Blessing; Eoin P Flanagan Journal: JAMA Neurol Date: 2019-01-01 Impact factor: 18.302
Authors: Elba Pascual-Goñi; Maria Josa; Cristian Launes; Luis Querol; Marga Del Cuerpo; M Alba Bosch; Iolanda Jordan; Eulàlia Turón-Viñas Journal: Front Neurol Date: 2019-05-24 Impact factor: 4.003