| Immunotherapy for refractory pulmonary infection after adult cardiac surgery: immune dysregulation syndrome. | |
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MedLine Citation:
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PMID: 16359060 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND AIM OF THE STUDY: Pulmonary dysfunction/multiorgan failure (PD/MF), usually due to refractory pulmonary infection, is an important cause of mortality and morbidity after cardiac operations. Moreover, the incidence of PD/MF may be increasing due to the emergence of antibiotic-resistant pathogens. METHODS: Fifteen consecutive patients (median age 69 years) who were developing antibiotic-refractory PD/MF were administered 24 g per day intravenous immunoglobulin (IV-IgG; Carimune) for five days. Ten patients had undergone complex valve surgery, and five coronary bypass. Preoperatively, 93% of patients had significant comorbidity, 73% presented acutely, 53% were hypoalbuminemic and 47% had antecedent acute pulmonary derangement. Clinical variables were assessed by retrospective chart review for three days prior to (-3) the start of IV-IgG (day 0) and for five days afterwards (+5). A postoperative morbidity index (PMI) was generated as a weighted sum of: worsening lung infiltrates (I); leukocytosis (L); pulmonary dysfunction (P); ventilator requirement (V); septic shock (S); renal (R), gastrointestinal (G), or hepatic (H) dysfunction; thrombocytopenia (T); and delirium (D). RESULTS: At day 0, all patients were refractory to major antibiotics, with morbidities of: 1-100%, L-93%, P-93%, V-60%, S-27%, R-67%, G-40%, H-13%, T-27%, and D-20%. Using regression analysis, IV-IgG administration was associated with a statistically significant fall in white blood count and improvement in PMI (p <0.006). Fourteen patients (93%) recovered uneventfully, and one patient (7%) died from progressive sepsis. No complications of IV-IgG therapy occurred. CONCLUSION: Given the high predicted mortality of PD/MF patients, these data suggest that IV-IgG is a safe and efficacious adjunct to antibiotics in this setting. Further studies, including a randomized trial and investigation of immunomodulatory mechanisms, seem indicated. |
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Authors:
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J Scott Rankin; Donald D Glower; Tracey L Teichmann; Lawrence H Muhlbaier; Charles W Stratton |
Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of heart valve disease Volume: 14 ISSN: 0966-8519 ISO Abbreviation: J. Heart Valve Dis. Publication Date: 2005 Nov |
Date Detail:
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Created Date: 2005-12-19 Completed Date: 2006-02-21 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9312096 Medline TA: J Heart Valve Dis Country: England |
Other Details:
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Languages: eng Pagination: 783-91 Citation Subset: IM |
Affiliation:
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Department of Cardiac Surgery, Vanderbilt University, 2400 Patterson Street, Suite 103, Nashville, TN 37203, USA. jsrankinmd@cs.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Bacterial Infections / etiology, therapy Cardiac Surgical Procedures* Drug Resistance, Multiple, Bacterial Female Humans Immunoglobulins, Intravenous / therapeutic use* Immunologic Factors / therapeutic use* Immunotherapy Leukocyte Count Lung Diseases / etiology, immunology, therapy* Male Middle Aged Postoperative Complications* / therapy Respiratory Tract Infections / etiology, immunology, therapy* |
| Chemical | |
Reg. No./Substance:
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0/Immunoglobulins, Intravenous; 0/Immunologic Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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