[Prevention with pseudomonas immune globulin in burn injury patients with inhalation trauma: does it have an effect...

In an evaluation of the effect of prophylactic application of Pseudomonas immunoglobulin on the immunoglobulin serum concentration, infection rate, lung function and mortality in major burn-trauma patients, a clinical, prospective, controlled and randomized trial along with an extensive literature review was carried out in the intensive care unit (ICU) of a major burn-trauma center at a major municipal hospital in the Federal Republic of Germany. A total of 60 patients suffering from major burn trauma were studied. Some of them exhibited inhalation injury as a secondary trauma. Inclusion criteria comprised an age of 15-60 years, burns covering 30%-70% of the body surface area, and second and third degree skin burns. In a randomized fashion, the consecutively admitted patients were assigned to either the study or the control group, each comprising 30 subjects. Study-group patients (PIG-GRP) received 250 mg/kg Pseudomonas immunoglobulin (Psomaglobin; Tropon-Cutter, Cologne, FRG) intravenously on days 3, 5, 7, 10 and 13 following the trauma, whereas controls (CON-GRP) received no prophylaxis. The immunoglobulin concentration was measured in serum on days 1, 3, 5, 7, 10, 13, 16, 19 and 28. From day 3 to day 13, significant higher values were found in study-group patients; however, this held true only for that subgroup of subjects in each group who displayed additional inhalation injury (PIG-SUBGRP = 23; CON-SUBGRP = 16). Immunoglobulin serum levels showed an earlier return to normal in the PIG-SUBGRP (day 7) than in the CON-SUBGRP (day 13). Blood cultures were taken on suspicion of septicaemia. In the above-described subgroups, the number of positive blood cultures was significantly reduced in the study patients (PIG-SUBGRP, 27 bacteremic subjects among a total of 70; CON-SUBGRP, 22 among a total of 36; P = 0.0045). In all, 21 subjects in the PIG-SUBGRP and 13 patients in the CON-SUBGRP were mechanically ventilated according to an adaptive scheme. The target value of pulmonary function was the O2 quotient (P(ALV)O2-P(ART)O2/P(ALV)O2), which was significantly closer to the normal value in the PIG-SUBGRP. Mortality was lower in the PIG-SUBGRP (34.8%, 8 patients) than in the CON-SUBGRP (50%, 8 subjects). In conclusion, prophylaxis with Pseudomonas immunoglobulin does not appear to be beneficial to burn trauma patients in general; however, it was shown to be effective in burn-trauma patients exhibiting inhalation injury.