Choosing a volume expander in critical care medicine.
The debate concerning the choice of crystalloids or colloids for resuscitation of the critically ill child is still unsettled. Moreover, the use of albumin in critically ill patients has been increasingly questioned because of the lack of clear-cut advantages over crystalloids as well as the concern for cost and the very minor risk of infection. Despite several meta-analyses addressing these issues, there is no data that supports the use of albumin unequivocally in any specific disease states. The suggestion that the use of albumin increases mortality in critically ill patients is not supported by data. There may be niche areas such as hypoalbuminic states, cirrhosis and burns where albumin may have distinct benefits. Alternatively synthetic colloids may be useful, however, concerns about coagulation problems and organ dysfunction persists.
Kissoon
Niranjan
N
University of Florida HSC/Jacksonville, Division of Pediatric Critical Care Medicine, Jacksonville, Florida 32207, USA. niranjan.kissoon@jax.ufl.edu
Bohn
Desmond
D
D001810:Blood Volume; D002648:Child; D003102:Colloids / Q000627:therapeutic use*; D003422:Critical Care; D000077324:Crystalloid Solutions; D005544:Forecasting; D006801:Humans; D007552:Isotonic Solutions; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012709:Serum Albumin / Q000627:therapeutic use*
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012709:Serum Albumin