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Colloids in the intensive care unit.
Am J Health Syst Pharm. 2012 Oct 01; 69(19):1635-42.AJ

Abstract

PURPOSE

The most recent published evidence on the use of colloids versus crystalloids in critical care is reviewed, with a focus on population-dependent differences in safety and efficacy.

SUMMARY

Colloids offer a number of theoretical advantages over crystalloids for fluid resuscitation, but some colloids (e.g., hydroxyethyl starch solutions, dextrans) can have serious adverse effects, and albumin products entail higher costs. The results of the influential Saline Versus Albumin Fluid Evaluation (SAFE) trial and a subsequent SAFE subgroup analysis indicated that colloid therapy should not be used in patients with traumatic brain injury and other forms of trauma due to an increased mortality risk relative to crystalloid therapy. With regard to patients with severe sepsis, two meta-analyses published in 2011, which collectively evaluated 82 trials involving nearly 10,000 patients, indicated comparable outcomes with the use of either crystalloids or albumins. For patients requiring extracorporeal cardiopulmonary bypass (CPB) during heart surgery, the available evidence supports the use of a colloid, particularly albumin, for CPB circuit priming and postoperative volume expansion. In select patients with burn injury, the published evidence supports the use of supplemental colloids if adequate urine output cannot be maintained with a crystalloid-only rescue strategy.

CONCLUSION

The results of the SAFE trial and a subgroup analysis of SAFE data suggest that colloids should be avoided in patients with trauma and traumatic brain injury. There are minimal differences in outcome between crystalloids and hypo-oncotic or iso-oncotic albumin for fluid resuscitation in severe sepsis; in select populations, such as patients undergoing cardiac surgery, the use of iso-oncotic albumin may confer a survival advantage and should be considered a first-line alternative.

Authors+Show Affiliations

Surgical Intensive Care, The Johns Hopkins Hospital, Baltimore, MD 21287-6180, USA. rkruer1@jhmi.eduNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

22997116

Citation

Kruer, Rachel M., and Christopher R. Ensor. "Colloids in the Intensive Care Unit." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 69, no. 19, 2012, pp. 1635-42.
Kruer RM, Ensor CR. Colloids in the intensive care unit. Am J Health Syst Pharm. 2012;69(19):1635-42.
Kruer, R. M., & Ensor, C. R. (2012). Colloids in the intensive care unit. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 69(19), 1635-42.
Kruer RM, Ensor CR. Colloids in the Intensive Care Unit. Am J Health Syst Pharm. 2012 Oct 1;69(19):1635-42. PubMed PMID: 22997116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colloids in the intensive care unit. AU - Kruer,Rachel M, AU - Ensor,Christopher R, PY - 2012/9/22/entrez PY - 2012/9/22/pubmed PY - 2013/2/21/medline SP - 1635 EP - 42 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 69 IS - 19 N2 - PURPOSE: The most recent published evidence on the use of colloids versus crystalloids in critical care is reviewed, with a focus on population-dependent differences in safety and efficacy. SUMMARY: Colloids offer a number of theoretical advantages over crystalloids for fluid resuscitation, but some colloids (e.g., hydroxyethyl starch solutions, dextrans) can have serious adverse effects, and albumin products entail higher costs. The results of the influential Saline Versus Albumin Fluid Evaluation (SAFE) trial and a subsequent SAFE subgroup analysis indicated that colloid therapy should not be used in patients with traumatic brain injury and other forms of trauma due to an increased mortality risk relative to crystalloid therapy. With regard to patients with severe sepsis, two meta-analyses published in 2011, which collectively evaluated 82 trials involving nearly 10,000 patients, indicated comparable outcomes with the use of either crystalloids or albumins. For patients requiring extracorporeal cardiopulmonary bypass (CPB) during heart surgery, the available evidence supports the use of a colloid, particularly albumin, for CPB circuit priming and postoperative volume expansion. In select patients with burn injury, the published evidence supports the use of supplemental colloids if adequate urine output cannot be maintained with a crystalloid-only rescue strategy. CONCLUSION: The results of the SAFE trial and a subgroup analysis of SAFE data suggest that colloids should be avoided in patients with trauma and traumatic brain injury. There are minimal differences in outcome between crystalloids and hypo-oncotic or iso-oncotic albumin for fluid resuscitation in severe sepsis; in select populations, such as patients undergoing cardiac surgery, the use of iso-oncotic albumin may confer a survival advantage and should be considered a first-line alternative. SN - 1535-2900 UR - https://www.unboundmedicine.com/medline/citation/22997116/Colloids_in_the_intensive_care_unit_ L2 - https://academic.oup.com/ajhp/article-lookup/doi/10.2146/ajhp110414 DB - PRIME DP - Unbound Medicine ER -