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Sepsis

Effects of intravenous IGM-enriched immunoglobulins on muscle tissue mircrocirculation in septic shock: a preliminary report

Cavazzuti I, Rinaldi L, Braccini MS, Bertolotti V, Andreotti A, Busani S, Girardis M. Int Care Med. 2009;35(Suppl 1):S239.

Introduction: In sepsis, multiple organ dysfunction is a consequence of cellular dysoxia caused mainly by microcirculation impairment. Intravenous polyclonal IgM-enriched immunoglobulins (IgGAM) have been recently re-evaluated as a valid therapeutic option in septic patients. The exact mechanism of action of IgGAM is still unclear, but the antitoxin and anti-inflammatory properties may influence the microcirculatory disturbances observed in sepsis. The aim of this study was to evaluate in patients with septic shock the effect of an early therapy with IgGAM on muscle tissue microcirculation by means of near infrared spectroscopy (NIRS).

Materials and Methods: From April 2008 to January 2009, 11 patients with septic shock treated according to the Surviving Sepsis Campaign (SSC) guidelines and IgGAM (5 ml/kg for 3 days) have been studied. IgGAM therapy in all the patients started within 24 h from shock appearance. Before, 24 h after and at the end of igGAM infusion the we measured by NIRS technique (InSpectra^TM, Hutchinson Technology, USA) and arterial occlusion test: baseline tissue O₂ saturation (StO₂bas), StO₂ downslope during ischemia (PStO₂), the StO₂ upslope (RStO₂) and the StO₂ overshoot (StO₂max) after reperfusion, and muscle VO₂ (nirVO₂). The NIRS probe was applied on patients thenar muscle and the ischemia/reperfusion test was obtained by inflation/deflation of a pneumatic cuff to 240 mmHg for 60 s. Data obtained in igGAM patients have been compared to NIRS data observed in 10 historical patients (control group) treated according to the SSC guidelines but without IgGAM. In these patients, NIRS data have been collected (i) within 24 h after shock development and (ii) 24 h after first measurement. In all the 21 patients activated recombinant protein C was not used because of contraindications.

Results: StO₂bas and PStO₂ remained constant during and after IgGAM therapy. RStO₂, StO₂max and nirVO₂ increased during IgGAM by about 15.8, 8.6 and 27.0% (p>0.05). Similarly, at end of IgGAM therapy reperfusion data and nirVO₂ were still larger (p>0.05) than data collected before IgGAM. In the control group we did not observed any NIRS data variation in the 2 time points of analysis.

Conclusions: The above preliminary data indicates that the early use of IgGAM in septic shock patients seems to affect muscular microcirculation with a rapid improvement in the parameters related to endothelial reactivity.