Gammaglobulins in critical care

The use of intravenous immunoglobulin (IVIG) is relatively infrequent in patients admitted to intensive care units (ICUs). However, “off-label” IVIG prescriptions for different conditions are highly prevalent. The aim of this paper is to review the existing evidence for the use of IVIG in patients admitted to ICUs, emphasizing non-infectious diseases and complications: hypogammaglobulinemia of the critically ill, hemophagocytic lymphohistiocytosis (HLH), Guillain-Barré syndrome (GBS), Kawasaki disease (KD), chylothorax, acute myocarditis, toxic shock syndrome (TSS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and sepsis. In conclusion, in critically ill patients, IVIG use is of benefit in KD, GBS, and TSS. It may benefit patients with fulminant acute myocarditis. The benefit is not proven in patients with HLH, chylothorax, and SJS/ TEN.