Principles of Immunomodulatory Therapy

Abstract

This chapter concerns the principles of immunomodulatory therapy for use in the neurologic intensive care unit (ICU). These principles, which are derived from those generally used for patients receiving immunomodulatory therapy, are particularly important in the ICU. This is because the side effects of the drugs used are considerable and will be compounded by the concurrent illnesses of patients in the ICU. However, there are differences between the use of these agents in the ICU setting and their use in the general clinical setting. For most intensive care patients the ICU stay is relatively short, and thus the long-term responsibility for immunomodulatory therapy will rest with other physicians. In many cases, patients in the ICU are sicker than others receiving immunomodulatory therapy, and the temptation is to use greater degrees of immunosuppression than would be used in the outpatient setting, in the belief that the potential benefit outweighs the additional risk. In selected cases this is justified, but this premise should be examined for each patient. As mentioned above, the complications and side effects of the individual agents should be borne in mind, as these will be exacerbated by the patient’s coexisting illnesses.