The Internet Book of Critical Care Podcast IBCC Episode 16 - Immune Checkpoint Inhibitors
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Dec 19, 2018 Learn about the mechanism of immune checkpoint inhibitors and their toxicities. Explore bronchoscopy in immunosuppressed patients, management of side effects like fungal infections and colitis, and evaluation for nephritis.
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General Treatment Approach
- Stop the checkpoint inhibitor and administer steroids as first-line therapy for most toxicities.
- If steroids fail, consider second-line immunosuppressants like anti-TNF, IVIG, or mycophenolate.
Cardiac Involvement Management
- For suspected myocarditis, consult cardiology and oncology promptly for potential high-dose steroid treatment.
- Evaluate with EKG, echo, hormone levels, troponin, and consider cardiac MRI.
Pneumonitis Evaluation
- For pneumonitis, obtain a chest CT scan (X-ray is insufficient), and consider bedside ultrasound.
- Rule out infections with cultures, procalcitonin, and antigen tests.