Intravenous Immune Globulin in Septic Shock: a Canadian National Survey of Critical Care Medicine and Infectious Disease Specialist Physicians

Overview

Journal Can J Anaesth

Specialty Anesthesiology

Date 2021 Feb 18

PMID 33598888

Citations 3

Authors

Murdoch Leeies

Hayley B Gershengorn

Emmanuel Charbonney

Anand Kumar

Dean Fergusson

Alexis F Turgeon

Juthaporn Cowan

Bojan Paunovic

John Embil

Allan Garland

Donald S Houston

Brett Houston

Emily Rimmer

Faisal Siddiqui

Bill Cameron

Srinivas Murthy

John C Marshall

Rob Fowler

Ryan Zarychanski

Affiliations

Soon will be listed here.

Abstract

Purpose: This national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock.

Methods: We conducted a cross-sectional survey of critical care and infectious diseases physicians across Canada. We summarized categorical item responses as counts and proportions. We developed a multivariable logistic regression model to identify physician-level predictors of IVIG use in septic shock.

Results: Our survey was disseminated to 674 eligible respondents with a final response rate of 60%. Most (91%) respondents reported having prescribed IVIG to patients with septic shock at least once, 86% for septic shock due to necrotizing fasciitis, 52% for other bacterial toxin-mediated causes of septic shock, and 5% for undifferentiated septic shock. The majority of respondents expressed uncertainty regarding the impact of IVIG on mortality (97%) and safety (95%) in septic shock. Respondents were willing to participate in further IVIG research with 98% stating they would consider enrolling their patients into a trial of IVIG in septic shock. Familiarity with published evidence was the single greatest predictor of IVIG use in septic shock (odds ratio, 10.2; 95% confidence interval, 3.4 to 30.5; P < 0.001).

Conclusions: Most Canadian critical care and infectious diseases specialist physicians reported previous experience using IVIG in septic shock. Respondents identified inadequacy of existing research as the greatest barrier to routine use of IVIG in septic shock. Most respondents support the need for further studies on IVIG in septic shock, and would consider enrolling their own patients into a trial of IVIG in septic shock.

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