Monday, April 7, 2014

Colloids Will Never Die

People love colloids.  Gross fluid resuscitation with crystalloids makes folks uncomfortable; the general dilutional effects and lack of oncotic pressure associated with crystalloids portends suboptimal volume replacement.

Yet, as we see again, the theoretical advantages of colloids are just that:  theoretical.

In this multi-center study from Europe, ICU patients were randomized – following initial resuscitation – to further resuscitation with crystalloids alone or crystalloids supplemented with albumin to a serum albumin target of 30g/L.  Groups were well-matched at baseline, in medical/surgical comorbidities, organ dysfunction, physiologic parameters, and pre-randomization resuscitation.  This excerpt from the authors’ conclusions condenses the results most simply:
“… the use of albumin in addition to crystalloids to correct hypoalbuminemia, as compared with the use of crystalloids alone, in patients with severe sepsis during their stay in the ICU did not provide a survival benefit at 28 or 90 days, despite improvements in hemodynamic variables.”
The last note is important, and reveals why this study will do nothing to change the use of natural and synthetic colloids for resuscitation:  clinicians love to make numbers look good, and colloids do that better than crystalloids.  Despite increased cost and no ultimate change in the primary outcome of mortality – or any secondary outcome of note – colloids improved hemodynamics in the short term.  Even though colloids are more costly, perhaps there are yet financial advantages to this small, early hemodynamic advantage?  Regardless, we are assured further research on this topic will continue apace.

My wife's contribution to this post:  other important colloids people love include whipped cream, gravy, ketchup, and Jello®.

“Albumin Replacement in Patients with Severe Sepsis or Septic Shock”
http://www.ncbi.nlm.nih.gov/pubmed/24635772

4 comments:

  1. As I looked into the evidence for DKA treatments, numerous papers still recommended colloids as well. None of them had any reason for giving it, just to do it if crystalloids "weren't working".
    Nonsense, all of it.

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  2. Did those papers mention anything about other important colloids (whipped cream, gravy, ketchup, or Jello®)?

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  3. Regular Jello® is bad for DKA. Further studies needed for the sugarfree version.

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  4. This comment has been removed by the author.

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