Prophylactic intravenous immune globulin and polymixin B decrease the incidence of septic episodes and hospital length of stay in severely burned children

Jefferson M. Lyons, Christopher Davis, Mary T. Rieman, Robert Kopcha, Ho H Phan, David G Greenhalgh, Tina L Palmieri, Richard Kagan

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

After burn shock resuscitation, serum gamma globulin levels decrease well below normal before slowly recovering over the course of 1 to 2 months. During this period, patients are vulnerable to further insult as a result of this immunocompromise. We hypothesized that intravenous immune globulin and subtherapeutic polymixin B (IVIG-B) could decrease the incidence and/or severity of sepsis after major thermal injury. A retrospective chart review from 1997 through 2003 at two hospitals compared patients who received IVIG-B (Hospital A) with those who did not (Hospital B). Patients with burns 40% or greater TBSA were included, whereas patients with nonsurvivable injuries were excluded from data analysis. A total of 152 patients were included in the study. One hundred two patients received IVIG-B, and 50 did not. Total burn size was 63.4% TBSA at Hospital A and 63.1% TBSA at Hospital B, with full-thickness burns of 54.4 and 61.7% TBSA, respectively (P < .05). Patients treated at Hospital A had a 51.9% incidence of inhalation injury compared with 28% of the patients at Hospital B (P < .05). There was an average of 1.2 and 1.9 septic episodes for patients treated at Hospital A and Hospital B, respectively (P < .05). Length of hospital stay was 77.1 days at Hospital A compared with 103.8 days at Hospital B (P < .05). Mortality was 17.6% and 18% at Hospitals A and B, respectively, and was not significantly different. Our data suggest that prophylactic IVIG-B is associated with a reduction in the incidence of septic episodes and decreased hospital length of stay following major thermal injury.

Original languageEnglish (US)
Pages (from-to)813-818
Number of pages6
JournalJournal of Burn Care and Research
Volume27
Issue number6
DOIs
StatePublished - Nov 2006
Externally publishedYes

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Intravenous Immunoglobulins
Length of Stay
Incidence
Wounds and Injuries
Burns
Hot Temperature
Serum Globulins
gamma-Globulins
Resuscitation
Inhalation
Shock
Sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Rehabilitation
  • Surgery

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Prophylactic intravenous immune globulin and polymixin B decrease the incidence of septic episodes and hospital length of stay in severely burned children. / Lyons, Jefferson M.; Davis, Christopher; Rieman, Mary T.; Kopcha, Robert; Phan, Ho H; Greenhalgh, David G; Palmieri, Tina L; Kagan, Richard.

In: Journal of Burn Care and Research, Vol. 27, No. 6, 11.2006, p. 813-818.

Research output: Contribution to journalArticle

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abstract = "After burn shock resuscitation, serum gamma globulin levels decrease well below normal before slowly recovering over the course of 1 to 2 months. During this period, patients are vulnerable to further insult as a result of this immunocompromise. We hypothesized that intravenous immune globulin and subtherapeutic polymixin B (IVIG-B) could decrease the incidence and/or severity of sepsis after major thermal injury. A retrospective chart review from 1997 through 2003 at two hospitals compared patients who received IVIG-B (Hospital A) with those who did not (Hospital B). Patients with burns 40{\%} or greater TBSA were included, whereas patients with nonsurvivable injuries were excluded from data analysis. A total of 152 patients were included in the study. One hundred two patients received IVIG-B, and 50 did not. Total burn size was 63.4{\%} TBSA at Hospital A and 63.1{\%} TBSA at Hospital B, with full-thickness burns of 54.4 and 61.7{\%} TBSA, respectively (P < .05). Patients treated at Hospital A had a 51.9{\%} incidence of inhalation injury compared with 28{\%} of the patients at Hospital B (P < .05). There was an average of 1.2 and 1.9 septic episodes for patients treated at Hospital A and Hospital B, respectively (P < .05). Length of hospital stay was 77.1 days at Hospital A compared with 103.8 days at Hospital B (P < .05). Mortality was 17.6{\%} and 18{\%} at Hospitals A and B, respectively, and was not significantly different. Our data suggest that prophylactic IVIG-B is associated with a reduction in the incidence of septic episodes and decreased hospital length of stay following major thermal injury.",
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