Human albumin solution for resuscitation and volume expansion in critically ill patients

,

doi:10.1002/14651858.cd001208.pub2

Cited by 26 publications

(9 citation statements)

References 63 publications

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“…The 28-day mortality was 21% and did not differ according to the treatment assignment with either albumin or normal saline. The finding is also in accordance with recent meta-analysis concerning the effects of albumin in critically ill patients [78,89,90]. However, subgroup analysis of the Albumin Reviewers' study [90] suggests that albumin may be related to an unfavorable outcome in trauma patients: the relative risk (95% confidence interval) for death with albumin in trauma patients was 1.36 (0.…”

Section: Colloid Choice For Hypovolemiasupporting

confidence: 87%

Colloid solutions: a clinical update

2010

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Albumin, dextran, gelatin, and hydroxyethyl starch (HES) solutions are colloids that efficiently expand the circulating blood volume. The administration of colloids restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone. However, colloids are always given for surgical and critically ill patients. The type of the colloid, volumes applied, aggressiveness of fluid resuscitation, and the volume status at the initial phase of administration determine their clinical responses. The outcome after fluid resuscitation with various colloids in critically ill patients seems to be comparable according to systematic reviews. A randomized, adequately powered clinical trial comparing modern nonprotein colloid to albumin is still lacking. Rapidly degradable HES solutions have good hemodynamic effects, and the risk of adverse renal and coagulation effects, as well as allergic reactions, is minimal. The current investigation has also shown the beneficial effect of HES solution (especially HES 130/0.4) on inflammatory response, postoperative nausea and vomiting, and postoperative outcome. The indication of colloids with an assessment of the degree of hypovolemia and safety profiles should thus be taken into consideration before colloid administration.

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Section: Colloid Choice For Hypovolemiasupporting

confidence: 87%

Colloid solutions: a clinical update

2010

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“…The question of which fluid is ideal for resuscitation remains unanswered and hence is pertinent globally 45 6 7 10 57 Differences in physiological dysfunction, speed of the development of shock, complications, and case fatality before intervention frustrate the development of a single fluid resuscitation strategy appropriate for all contexts.…”

Section: Discussionmentioning

confidence: 99%

“…4 5 6 7 8 9 10 11 Although physiological explanations have been advanced to support potential benefits of colloids over crystalloids, the current evidence does not support these 34 5 Earlier Cochrane meta-analyses concluded that human albumin solution resulted in increased mortality,3 5 6 but these conclusions were disputed and a subsequent meta-analysis showed that use of human albumin solution or 0.9% saline resulted in similar survival 4. This conclusion was greatly influenced by the results of a trial of human albumin solution compared with saline in 7000 adults in Australia and New Zealand (SAFE study), which reported similar survival in both treatment arms 12.…”

Section: Introductionmentioning

confidence: 99%

Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Akech

Ledermann

Maitland

2010

BMJ

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Objective To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with severe infection.Data sources Medline (1950-2008), PubMed, the Cochrane Library, Embase (1980-2008), and reference lists.Eligibility criteria Published studies comparing fluid resuscitation with crystalloid or colloidal solutions in severe infectious illness in children aged >1 month to ≤12 years. Controlled trials and randomised controlled trials were separately selected by two unblinded investigators who also independently extracted data.Main outcome measures Efficacy in the treatment of shock, mortality, and reported adverse events.Results Nine trials fulfilled criteria, eight of which compared crystalloids with colloids. All trials were conducted in settings with poor resources and predominantly included patients with malaria or dengue haemorrhagic shock. None of the trials had mortality as a primary outcome. Three out of six studies that reported at least one death showed better survival in children resuscitated with colloids compared with crystalloids (Peto fixed odds ratio ranging from 0.18 (95% confidence interval 0.02 to 1.42) to 0.48 (0.06 to 3.99)). Studies contributing data on mortality had some methodological limitations so caution is recommended when interpreting this finding. Studies were heterogeneous so combined estimates were not calculated. The review was limited by inclusion of only published studies.Conclusions The current evidence on choice of fluids for resuscitation in children with infections is weak. While existing trials have provided important evidence in malaria and dengue, resuscitation in children with paediatric sepsis, for which colloids could theoretically be of benefit, has not been studied. The evidence from existing studies is not robust enough to make any definitive recommendations over the choice of resuscitation fluid and a definitive trial is required to address this.

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“…In 1 large LOE 5 randomized controlled trial of fluid therapy in adult ICU patients 406 and in 6 good-quality LOE 5 meta-analyses, predominantly of adults, 407–412 no mortality differences were noted when colloid was compared with hypertonic and isotonic crystalloid solutions, and no differences were noted between types of colloid solutions.…”

Section: Arrhythmia Therapypeds-030mentioning

confidence: 99%

Part 10: Pediatric Basic and Advanced Life Support

Kleinman

Caen

Chameides³

et al. 2010

Circulation

184

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Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.

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Human albumin solution for resuscitation and volume expansion in critically ill patients

Cited by 26 publications

References 63 publications

Colloid solutions: a clinical update

Colloid solutions: a clinical update

Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Part 10: Pediatric Basic and Advanced Life Support

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