IVIG Administration: Lessons from Cross-Institutional Protocol Review

Background: Intravenous immunoglobulin (IVIG) is used in the acute care, including neurocritical care, setting for a variety of autoimmune and inflammatory conditions. Incidence and severity of infusion-related reactions have been found to be affected by several key factors, including osmolarity, sodium and IgA content, and infusion rate. The purpose of this study was to survey and synthesize IVIG-related practices across various hospitals into a practical guide for clinicians and provide a reference for reviewing or developing IVIG infusion protocols. Methods: Pharmacists from the Neurocritical Care Society Connect online forum were invited to participate in a survey regarding their institutional protocols related to IVIG infusions in the inpatient setting. Results: Data were collected from 12 participating medical centers, all of which have dedicated neurocritical care units. The most common formulation of IVIG used was Privigen^®, followed by Gammagard^®. Gamunex^®-C was only used at two centers. Starting rates for IVIG infusions ranged from 0.3 to 0.6 mL/kg/hr with increases every 15 to 30 minutes. Maximum infusion rates were heterogenous ranging from 2 to 8 mL/kg/hr and often reduced in high-risk populations, such as renal impairment or older age. Significant variation in medication selection and standardization was identified in pre-medication practices and management of adverse reactions. Conclusion: This study highlights the variability in IVIG administration protocols and underscores the need for standardized practices to enhance patient safety and treatment efficacy.