title: The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries.
abstract: OBJECTIVE
  Although 4% albumin is associated with increased mortality in patients with traumatic brain injury (TBI), evidence concerning the safety of synthetic colloids is lacking. We aimed to determine if there is an association between synthetic colloids and mortality in patients with severe TBI.
  
  
  METHODS
  A retrospective cohort study of patients with severe TBI was conducted. Data were collected on all intravenous fluids administered during the first 14 days of admission. Multivariable Cox proportional hazards regression was used to model the association between daily cumulative pentastarch quintiles and mortality.
  
  
  RESULTS
  Patients receiving pentastarch had higher Acute Physiology and Chronic Health II scores (23.9 vs 21.6, P < .01), frequency of craniotomy (42.5% vs 21.6%, P = .02), longer duration of intensive care unit stay (12 vs 4 days, P < .01), and mechanical ventilation (10 vs 3 days, P < .01). On unadjusted Cox regression, patients in the highest quintile of cumulative pentastarch administration had a higher rate of mortality compared with those receiving no colloid (hazard ratio, 3.8; 95% confidence interval, 1.2-12.4; P = .03). However, this relationship did not persist in the final multivariable model (hazard ratio 1.0; 95% confidence interval, 0.25-4.1; P = .98).
  
  
  CONCLUSIONS
  There was no association between cumulative exposure to pentastarch and mortality in patients with severe TBI.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Mypinder S
authors.initials: MS
authors.lastname: Sekhon
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Dhingra
authors.forename: Indeep S
authors.initials: IS
authors.lastname: Sekhon
authors.forename: William R
authors.initials: WR
authors.lastname: Henderson
authors.forename: Neilson
authors.initials: N
authors.lastname: McLean
authors.forename: Donald E G
authors.initials: DE
authors.lastname: Griesdale
mesh_terms: D018806:APACHE; D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D003102:Colloids / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D010952:Plasma Substitutes / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015599:Trauma Severity Indices; D016896:Treatment Outcome
chemical_list: D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes