In this pediatric series, CroFab appears safe and effective, despite occasional resistant thrombocytopenia.

SummaryAll patients admitted to an Intensive Care Unit were randomised to receive all volume replacement fluid as either human albumin solution or a synthetic colloid. A total of 475 patients were admitted during the study period. Patients' age, sex, APACHE score and calculated risk of death were assessed on admission. Outcome was assessed as length of Intensive Care stay and mortality. There was no difference between the groups. Subgroups of patients with APACHE score greater than 10, calculated risk of death greater than 50% and length of stay greater than 5 days were also evaluated but no significant differences were found between treatment groups. The use of albumin rather than 3.5% polygeline for volume replacement in the Intensive Care Unit has no influence on outcome.

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SummaryAll patients admitted to an Intensive Care Unit were assigned randomly to one of two groups, A and B. Group A received colloid volume replacement as 4.5% albumin whilst group B received a synthetic colloid, polygeline. This study describes the changes in serum albumin concentration in survivors and nonsurvivors in the two groups during their stay in the Intensive Care Unit. The incidences of renal failure and pulmonary oedema were also assessed. Serum albumin concentration decreased in all nonsurvivors. In survivors the serum albumin concentration decreased to a greater extent in the synthetic colloid group than in the albumin group. Despite the differences in serum albumin concentration there were no signiJicant differences between the groups in the incidences of pulmonary oedema or renal failure. Key wordsFluid balance; intravenous fluid, colloid. Protein; albumin.Albumin solution is used commonly for volume replacement in the critically ill. The choice of resuscitation fluid has been discussed extensively in the literature, with emphasis almost entirely on the acute haemodynamic effects of available solutions [I]. Many of the arguments supporting the use of albumin relate to the potential physiological advantages of this solution in the medium to long term but there are little or no data confirming the validity of these considerations. The theoretical arguments which would suggest that albumin has advantages over synthetic equivalents [2] include its ability to bind anions and cations [3], its role as a scavenger of free radicals [4] and its influence on microvascular integrity.A study was undertaken to determine whether these differences resulted in a measurable change in outcome and the results are described elsewhere [5]. Daily serum albumin measurements were made but no action was taken to correct the serum albumin concentration towards normal. This paper describes the changes in serum albumin concentration which occurred when synthetic colloid was used rather than albumin as a volume replacement fluid in critically ill patients. In addition, two specific problems have been described in relation to the use of colloids and the maintenance of serum albumin. The first is renal failure and the second the development of pulmonary oedema. The occurrences of these complications were assessed.

The organisation and the workload i$ the anaesthetic department of a Field Hospital deployed during the Gulf' war were described. Suggestions are made as to how the problems encountered might be overcome in the future.