Acute and Critical Care

Original Article

Surgery
Adjuvant intravenous immunoglobulin administration on postoperative critically ill patients with secondary peritonitis: a retrospective study: Young Un Choi, Jun Gi Kim, Ji Young Jang, Tae Hwa Go, Kwangmin Kim, Keum Seok Bae, Hongjin Shim; Acute Crit Care. 2023;38(1):21-30. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01515; Correction in: Acute Crit Care 2023;38(2):250

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Background
The use of intravenous immunoglobulin (IVIG) in sepsis patients from bowel perforation is still debatable. However, few studies have evaluated the effect of IVIG as an adjuvant therapy after source control. This study aimed to analyze the effect of IVIG in critically ill patients who underwent surgery due to secondary peritonitis.
Methods
In total, 646 medical records of surgical patients who were treated for secondary peritonitis were retrospectively analyzed. IVIG use, initial clinical data, and changes in Sequential Organ Failure Assessment (SOFA) score over the 7-day admission in the intensive care unit for sepsis check, base excess, and delta neutrophil index (DNI) were analyzed. Mortalities and periodic profiles were assessed. Propensity scoring matching as comparative analysis was performed in the IVIG group and non-IVIG group.
Results
General characteristics were not different between the two groups. The survival curve did not show a significantly reduced mortality in the IVIG. Moreover, the IVIG group did not have a lower risk ratio for mortality than the non-IVIG group. However, when the DNI were compared during the first 7 days, the reduction rate in the IVIG group was statistically faster than in the non-IVIG group (P<0.01).
Conclusions
The use of IVIG was significantly associated with faster decrease in DNI which means faster reduction of inflammation. Since the immune system is rapidly activated, the additional use of IVIG after source control surgery in abdominal sepsis patients, especially those with immunocompromised patients can be considered. However, furthermore clinical studies are needed.

Citations

Citations to this article as recorded by

USING INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH SEPTIC SHOCK AND MULTIPLE COMORBIDITIES: A REVIEW BASED ON A CLINICAL CASE
Nataliya Matolynets, Jacek Rolinski, Khrystyna Lishchuk-Yakymovych, Yaroslav Tolstyak
Proceeding of the Shevchenko Scientific Society. Medical Sciences.2023;[Epub] CrossRef

Case Reports

Pulmonary
Successful Immunoglobulin Treatment in Severe Cryptogenic Organizing Pneumonia Caused by Dermatomyositis: Dong Hoon Lee, Jee Hyun Yeo, Young Il Kim, Seung Jun Gim, Jang Won Sohn, Ji Young Yhi; Korean J Crit Care Med. 2015;30(3):212-217. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.212

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Abstract PDF

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.

Citations

Citations to this article as recorded by

A Case Report of Steroid-Resistant Cryptogenic Organizing Pneumonia Managed with Intravenous Immunoglobulins
Christian Akem Dimala, Urvi Patel, Benjamin Lloyd, Anthony Donato, William B. Kimmel, Robert Hallowell, Caitlyn Moss, Tun-Chieh Chen
Case Reports in Pulmonology.2021; 2021: 1. CrossRef

Infection
Kawasaki Disease with Acute Respiratory Distress Syndrome after Intravenous Immunoglobulin Infusion: Yu Hyeon Choi, Bong Jin Lee, June Dong Park, Seung Hyo Kim; Korean J Crit Care Med. 2014;29(4):336-340. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.336

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Abstract PDF

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.

Citations

Citations to this article as recorded by

French national diagnostic and care protocol for Kawasaki disease
C. Galeotti, F. Bajolle, A. Belot, S. Biscardi, E. Bosdure, E. Bourrat, R. Cimaz, R. Darbon, P. Dusser, O. Fain, V. Hentgen, V. Lambert, A. Lefevre-Utile, C. Marsaud, U. Meinzer, L. Morin, M. Piram, O. Richer, J.-L. Stephan, D. Urbina, I. Kone-Paut
La Revue de Médecine Interne.2023; 44(7): 354. CrossRef

Cardiology/Pediatric
Acute Myocardial Infarction during the Subacute Phase of Refractory and Incomplete Kawasaki Disease in a Five-year-old Boy: Chul Jin, Yeo Hyang Kim, Hyung Seop Kim; Korean J Crit Care Med. 2014;29(1):23-26. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.23

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Abstract PDF: Kawasaki disease (KD) is an acute, systemic vasculitis of childhood. The early mortality of KD results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction, and the subacute phase of KD has the highest risk of mortality. Although there have been reports of ischemic heart disease as late cardiologic sequelae of KD in young adults, acute myocardial infarction caused by coronary complications in the subacute phase of KD is rare. We experienced one pediatric patient who developed coronary artery aneurysm and acute myocardiac infarction (AMI) during the subacute phase of incomplete and intravenous immunoglobulin (IVIG)-nonresponsive KD. The patient was given a good prognosis due to close monitoring and early recognition of AMI. Physicians should carefully monitor KD patients who do not respond to initial IVIG therapy and who show progressive coronary artery dilatation. If such a patient complaints of chest pain and the ECG shows hyperacute T waves, the physician should suspect development of AMI.

Successful Empirical Treatment of Intravenous Immune Globulin in Recent-Onset Idiopathic Dilated Cardiomyopathy: A Case Report: Hyun Soo Kim, Keum Nam Rim, Hyun Jong Shin, Sang Pyo Lee, Sang Bong Ahn, Yong Gu Lee, Young Chul Lee, Na Rae Ha, Sun Joo Chang, Jin Ho Shin; Korean J Crit Care Med. 2007;22(2):96-100.

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Abstract PDF: Intravenous immunoglobulin (IVIG) therapy has been introduced to idiopathic dilated cardiomyopathy due to their antiviral and anti-inflammatory effects. But each study reported conflicting result and treatment regimen has not been clearly established. We experienced a case of 28-year-old woman with idiopathic dilated cardiomyopathy with severely depressed cardiac function. Its onset time was obvious within 1 month. Despite of conservative treatment of heart failure, sudden cardiac arrest was developed. We tried IVIG therapy, and her symptoms and cardiac function were improved after IVIG treatment.

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