Colloid solutions in the critically ill

Abstract

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.

Serum albumin: touchstone or totem?

“…In more recent studies, investigators have focused on the influence of albumin on duration of ICU stay and rate of recovery. A prospective randomised study of albumin versus gelatin solutions for routine fluid replacement in 475 ICU patients did not show any significant differences between duration of stay, complications or outcomes in the two groups [61]. There are several other studies which failed to show a benefit in using albumin solutions although in all of these studies it was clear that the serum albumin values remained elevated.…”

Albumin Infusion is not Beneficial in Hypoalbuminemic End-Stage Cancer Patients: A Matched-Pair Analysis

“…21 A prospective randomized study of albumin versus gelatin solutions for routine fluid replacement in 475 intensive care unit patients did not show any significant differences between duration of stay, complications or outcomes in the two groups. 22 Unfortunately, albumin treatment appears to increase the relative risk for death in trauma, surgery or burns patients with hypoalbuminemia. 23 In our study, we found that the albumin infusion was associated with shorter survival.…”

Should Albumin Be Used to Correct Hypoalbuminemia in the Critically Ill? No

“…40 A prospective randomized study of albumin versus gelatin solutions for routine fluid replacement in 475 ICU patients did not show any significant differences between duration of stay, complications or outcomes in the two groups. 41 Low serum albumin concentrations are a marker of an underlying disease and not a cause of it. The correction of hypoalbuminemia, so far, has not resulted in a more favorable outcome.…”