Evidence-based Colloid Use in the Critically Ill

doi:10.1164/rccm.200208-909st

Cited by 117 publications

(25 citation statements)

References 227 publications

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“…Clearly there is much about the physiologic effects of albumin that is not yet well understood [8]. These effects are probably altered in various disease states, particularly those associated with oxidant stress such as sepsis, but whether and how these changes are involved in the pathogenesis of these conditions requires further elucidation.…”

Section: Some Backgroundmentioning

confidence: 99%

“…There would therefore seem to be a good rationale for use of albumin infusions in critically ill patients. However, albumin solutions also have limitations, including high costs relative to possible alternatives, notably crystalloids, and potential (rare) risks of transmission of microorganisms, anticoagulant, and allergic effects [6-8]. Because there are no definitive randomized controlled trials (RCTs) demonstrating an outcome benefit of albumin in heterogeneous groups of critically ill patients, routine administration of albumin for fluid resuscitation is not warranted in all patients, but there is evidence to support its use in some patient populations.…”

Section: Introductionmentioning

confidence: 99%

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Albumin administration in the acutely ill: what is new and where next?

et al. 2014

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Albumin solutions have been used worldwide for the treatment of critically ill patients since they became commercially available in the 1940s. However, their use has become the subject of criticism and debate in more recent years. Importantly, all fluid solutions have potential benefits and drawbacks. Large multicenter randomized studies have provided valuable data regarding the safety of albumin solutions, and have begun to clarify which groups of patients are most likely to benefit from their use. However, many questions remain related to where exactly albumin fits within our fluid choices. Here, we briefly summarize some of the physiology and history of albumin use in intensive care before offering some evidence-based guidance for albumin use in critically ill patients.

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Section: Some Backgroundmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Albumin administration in the acutely ill: what is new and where next?

et al. 2014

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“…Demographics, co-morbid conditions, vital signs, laboratory data, and compliance data were collected. The volumes of 6% hydroxyethyl starch and 20% albumin were converted into equivalent dosages of crystalloid [26]. Severity-of-illness scores were calculated, including the acute physiology and chronic health evaluation (APACHE) II scores and sequential organ failure assessment (SOFA) scores.…”

Section: Methodsmentioning

confidence: 99%

Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country

Guo¹,

Li²,

Li³

et al. 2014

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IntroductionValidation of compliance with severe sepsis bundles is still needed. The purpose of this study was to determine compliance and its outcomes in severe community-acquired pneumonia (CAP) patients in a limited resources country.Material and methodsA prospective cohort study of 212 severe CAP patients was carried out. The implementation programme was organized into two continuous phases. The primary outcomes were compliance and hospital mortality.ResultsCompliance with administration of antibiotics and vasopressors as well as plateau pressure on average < 30 cm H2O was high in both groups. In the bundles group, patients received more serum lactate monitoring (62.3% vs. 11.3%), more blood cultures (47.1% vs. 24.5%), more fluid resuscitation (63.2% vs. 26.4%) and volumes infused (1319.8 ±1107.4 ml vs. 461.9 ±799.3 ml), more inotropic dobutamine and/or packed red blood cells (21.7% vs. 10.0%), more low-dose steroids (56.5% vs. 15.0%), and more glucose control (51.9% vs. 6.6%) compared with such patients in the control group. The rates of total compliance with 6-hour, 24-hour, and 6/24-hour bundles in the prospective period were 47.1%, 51.9%, and 42.5%, respectively. Hospital mortality was reduced from 44.3% to 29.2% (p = 0.023) in the bundles group, and the compliant subgroup had a more than twofold decrease in mortality (17.8% vs. 37.7%, p = 0.003). Serum lactate measured, blood cultures, and fluid resuscitation showed independent relationships with decreased mortality.ConclusionsTotal compliance was relatively low, but the implementation of severe sepsis bundles could clearly reduce mortality from severe CAP.

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“…Thus, to achieve similar restoration of blood volume, more volume of crystalloid may be necessary, with unwanted excess edema. 3 However, shock states, such as sepsis, induce endothelial leak with extravasation of protein and other large molecules, 4 which undermines the theoretical advantage of colloids. Furthermore, colloids are considerably more expensive; human-derived colloids, such as albumin, carry theoretical risks of infection; and the large molecule proteins and starches may have unwanted immunogenic effects.…”

mentioning

confidence: 99%

“…Furthermore, colloids are considerably more expensive; human-derived colloids, such as albumin, carry theoretical risks of infection; and the large molecule proteins and starches may have unwanted immunogenic effects. 3 Some starches also appear to cause renal injury. 5 …”

mentioning

confidence: 99%