Colloid solutions in the critically ill

Stockwell, Martin; Soni, Neil; Riley, Bradley D.

doi:10.1111/j.1365-2044.1992.tb01941.x

Cited by 90 publications

(9 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In an open question, only 2 ICUs specified that they have adapted their strategy according to recently published papers showing the ineffectiveness of volume therapy with albumin with regard to patients' outcome or in elevating a low albumin concentration in the critically ill [8][9][10][11][12][13][14][15]. Astonishingly, on some ICUs albumin is given although the responsible physician is not convinced of its benefit ["forced (not convinced) by the surgeons"].…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Volume replacement strategies on intensive care units: results from a postal survey

1998

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Volume replacement strategies on intensive care units: results from a postal survey

1998

View full text Add to dashboard Cite

show abstract

“…Synthetic colloids, e. g., hydroxyethylstarch solution (HES), are much less costly, but the concerns about the use of HES include possible alterations in coagulation [9,10], allergic reactions, and possible accumulation in the reticuloendothelial system. Volume therapy with albumin is recommended because it is suggested that albumin may bind cations and anions, may serve as a scavenger of free radicals, and may beneficially influence microvascular integrity without exerting any negative effects [11,12]. Unfortunately, in most studies the effects of fluid therapy were assessed over hours rather than over days [13].…”

Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Volume therapy in the critically ill: is there a difference?

et al. 1998

View full text Add to dashboard Cite

show abstract

“…Several types of colloid are available for clinical use—all differ in their molecular weight, colloid osmotic pressure, half-life in the intravascular compartment, and side-effect profile, mainly allergic reactions and adverse effects on coagulation [ 11 , 12 ]. We opted to test one of the modified gelatins, as these are the cheapest, most widely available colloid and have been shown in clinical trials to have a similar efficacy to albumin and other colloids [ 13 – 15 ]. Here we compare the safety and efficacy of Gelofusine (a succinylated modified fluid gelatin 4% intravenous infusion) and albumin in children with severe malaria complicated by metabolic acidosis.…”

Section: Introductionmentioning

confidence: 99%

Volume Expansion with Albumin Compared to Gelofusine in Children with Severe Malaria: Results of a Controlled Trial

et al. 2006

View full text Add to dashboard Cite

Objectives:Previous studies have shown that in children with severe malaria, resuscitation with albumin infusion results in a lower mortality than resuscitation with saline infusion. Whether the apparent benefit of albumin is due solely to its colloidal properties, and thus might also be achieved with other synthetic colloids, or due to the many other unique physiological properties of albumin is unknown. As albumin is costly and not readily available in Africa, examination of more affordable colloids is warranted. In order to inform the design of definitive phase III trials we compared volume expansion with Gelofusine (succinylated modified fluid gelatin 4% intravenous infusion) with albumin.Design:This study was a phase II safety and efficacy study.Setting:The study was conducted at Kilifi District Hospital, Kenya.Participants:The participants were children admitted with severe falciparum malaria (impaired consciousness or deep breathing), metabolic acidosis (base deficit > 8 mmol/l), and clinical features of shock.Interventions:The interventions were volume resuscitation with either 4.5% human albumin solution or Gelofusine.Outcome Measures:Primary endpoints were the resolution of shock and acidosis; secondary endpoints were in-hospital mortality and adverse events including neurological sequelae.Results:A total of 88 children were enrolled: 44 received Gelofusine and 44 received albumin. There was no significant difference in the resolution of shock or acidosis between the groups. Whilst no participant developed pulmonary oedema or fluid overload, fatal neurological events were more common in the group receiving gelatin-based intervention fluids. Mortality was lower in patients receiving albumin (1/44; 2.3%) than in those treated with Gelofusine (7/44; 16%) by intention to treat (Fisher's exact test, p = 0.06), or 1/40 (2.5%) and 4/40 (10%), respectively, for those treated per protocol (p = 0.36). Meta-analysis of published trials to provide a summary estimate of the effect of albumin on mortality showed a pooled relative risk of death with albumin administration of 0.19 (95% confidence interval 0.06–0.59; p = 0.004 compared to other fluid boluses).Conclusions:In children with severe malaria, we have shown a consistent survival benefit of receiving albumin infusion compared to other resuscitation fluids, despite comparable effects on the resolution of acidosis and shock. The lack of similar mortality benefit from Gelofusine suggests that the mechanism may involve a specific neuroprotective effect of albumin, rather than solely the effect of the administered colloid. Further exploration of the benefits of albumin is warranted in larger clinical trials.

show abstract

Colloid solutions in the critically ill

Cited by 90 publications

References 18 publications

RETRACTED ARTICLE: Volume replacement strategies on intensive care units: results from a postal survey

RETRACTED ARTICLE: Volume replacement strategies on intensive care units: results from a postal survey

RETRACTED ARTICLE: Volume therapy in the critically ill: is there a difference?

Volume Expansion with Albumin Compared to Gelofusine in Children with Severe Malaria: Results of a Controlled Trial

Contact Info

Product

Resources

About