Skip to main content
SpringerLink
Log in

Choosing a volume expander in critical care medicine

  • Special Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MTet al. Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock.Crit Care Med 1983; 11: 839–850.

    Article  PubMed  CAS  Google Scholar 

  2. Dienes HP, Gerharz CD, Wagner R, Weber M, and John HD. Accumulation of hydroxyethyl starch (HES) in the liver of patients with renal failure and portal hypertension.J Hepatol 1986; 3:223–227.

    Article  PubMed  CAS  Google Scholar 

  3. Sirtl C, Laubenthal H, Zumtobel V, Kraft D, and Jurecka W. Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related.Br J Anaesth 1999; 82: 510–515.

    PubMed  CAS  Google Scholar 

  4. Lamke LO, Liljedahl SO. Plasma volume changes after infusion of various plasma expanders.Resuscitation 1976; 5:93–102.

    Article  PubMed  CAS  Google Scholar 

  5. Lazrove S, Waxman K, Shippy C, Shoemaker WC. Hemodynamic, blood volume, and oxygen transport responses to albumin and hydroxyethyl starch infusions in critically ill postoperative patients.Crit Care Med 1980; 8:302–306.

    Article  PubMed  CAS  Google Scholar 

  6. Boldt J, Knothe C, Schindler E, Hammermann H, Dapper F, and Hempelmann G. Volume replacement with hydroxyethyl starch solution in children.Br J Anaesth 1993; 70: 661–665.

    Article  PubMed  CAS  Google Scholar 

  7. Brutocao D, Bratton SL, Thomas JR, Schrader PF, Coles PG, and Lynn AM. Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass.J Cardiothorac Vasc Anesth 1996; 10: 348–351.

    Article  PubMed  CAS  Google Scholar 

  8. Strauss RG. Review of the effects of hydroxyethyl starch on the blood coagulation system.Transfusion 1981; 21: 299–302.

    Article  PubMed  CAS  Google Scholar 

  9. Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients.Lancet 1996; 348:1620–1622.

    Article  PubMed  CAS  Google Scholar 

  10. Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire Fet al. Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study.Lancet 2001; 357:911–916.

    Article  PubMed  CAS  Google Scholar 

  11. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials.BMJ 1998; 316:961–964.

    PubMed  CAS  Google Scholar 

  12. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review.Crit Care Med 1999; 27: 200–210.

    Article  PubMed  CAS  Google Scholar 

  13. Apelgren KN, Rombeau JL, Twomey PL, Miller RA. Comparison of nutritional indices and outcome in critically ill patients.Crit Care Med 1982; 10: 305–307.

    Article  PubMed  CAS  Google Scholar 

  14. Bradley JA, Cunningham KJ, Jackson VJ, Hamilton DN, Ledingham IM. Serum protein levels in critically ill surgical patients.Intensive Care Med 1981; 7: 291–295.

    Article  PubMed  CAS  Google Scholar 

  15. Marik PE. The treatment of hypoalbuminemia in the critically ill patient.Heart Lung 1993; 22:166–170.

    PubMed  CAS  Google Scholar 

  16. Murray MJ, Marsh HM, Wochos DN, Moxness KE, Offord KP, Callaway CW. Nutritional assessment of intensive-care unit patients.Mayo Clin Proc 1988; 63:1106–1115.

    PubMed  CAS  Google Scholar 

  17. Phillips A, Shaper AG, Whincup PH. Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes.Lancet 1989; 2:1434–1436.

    Article  PubMed  CAS  Google Scholar 

  18. Reinhardt GF, Myscofski JW, Wilkens DB, Dobrin PB, Mangan JE, Jr., Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans.JPENJ Parenter Enterai Nutr 1980; 4:357–359.

    CAS  Google Scholar 

  19. Sapijaszko MJ, Brant R, Sandham D, Berthiaume Y. Nonrespiratory predictor of mechanical ventilation dependency in intensive care unit patients.Crit Care Med 1996; 24:601–607.

    Article  PubMed  CAS  Google Scholar 

  20. Sun X, Lies M, Weissman C. Physiologic variables and fluid resuscitation in the postoperative intensive care unit patient.Crit Care Med 1993; 21:555–561.

    Article  PubMed  CAS  Google Scholar 

  21. Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ, Kasiske BL. Serum albumin and mortality after renal transplantation.Am J Kidney Dis 1996; 27:117–123.

    PubMed  CAS  Google Scholar 

  22. McCluskey A, Thomas AN, Bowles BJ, Kishen R. The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit.Anaesthesia 1996; 51: 724–727.

    PubMed  CAS  Google Scholar 

  23. Blunt MC, Nicholson JP, and Park GR. Serum albumin and colloid osmotic pressure in survivors and nonsurvivors of prolonged critical illness.Anaesthesia 1998; 53: 755–761.

    Article  PubMed  CAS  Google Scholar 

  24. Quinlan GJ, Margarson MP, Mumby S, Evans TW, Gutteridge JM. Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion.Clin Sci (Lond) 1998; 95:459–465.

    Article  CAS  Google Scholar 

  25. Heck A, Raines G, Hawker F, Trotter J, Wallace PI, Ledingham IM, Caiman KC. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury.Lancet 1985; 1:781–784.

    Google Scholar 

  26. Bland RD, Clarke TL, Harden LB. Rapid infusion of sodium bicarbonate and albumin into high-risk premature infants soon after birth: a controlled, prospective trial.Am J Obstet Gynecol 1976; 124: 263–267.

    PubMed  CAS  Google Scholar 

  27. Greenough A, Emery E, Hird MF, Gamsu HR. Randomised controlled trial of albumin infusion in ill preterm infants.Eur J Pediatr 1993; 152:157–159.

    Article  PubMed  CAS  Google Scholar 

  28. Kanarek KS, Williams PR, Blair C. Concurrent administration of albumin with total parenteral nutrition in sick newborn infants.JPEN J Parenter Enterai Nutr 1992; 16:49–53.

    CAS  Google Scholar 

  29. So KW, Fok TF, Ng PC, Wong WW, Cheung KL. Randomised controlled trial of colloid or crystalloid in hypotensive preterm infants.Arch Dis Child Fetal Neonatal Ed 1997; 76: F43-F46.

    PubMed  CAS  Google Scholar 

  30. Wong W, Fok TF, Lee CH, Ng PC, So KW, Ou Y, Cheung KL. Randomised controlled trial: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia.Arch Dis Child Fetal Neonatal Ed 1997; 77:F115-F118.

    PubMed  CAS  Google Scholar 

  31. Stoddart PA, Rich P, Sury MR. A comparison of 4.5% human albumin solution and Haemaccel in neonates undergoing major surgery.Pediatr Anaesth 1996; 6:103–106.

    Article  CAS  Google Scholar 

  32. Riegger LQ, Voepel-Lewis T, Kulik TJ, Malviya S, Tait AR, Mosca RSet al. Albumin versus crystalloid prime solution for cardiopulmonary bypass in young children.Crit Care Med 2002; 30:2649–2654.

    Article  PubMed  CAS  Google Scholar 

  33. Greenhalgh DG, Housinger TA, Kagan RJ, Rieman M, James L, Novak S, Farmer Let al. Maintenance of serum albumin levels in pediatric burn patients: a prospective, randomized trial.J Trauma 1995; 39: 67–73.

    Article  PubMed  CAS  Google Scholar 

  34. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers.BMJ 1998; 317: 235–240.

Download references

Author information

Author notes

  1. Desmond Bohn

    Present address: Division of Pediatric Critical Care Medicine, University of Florida HSC/Jacksonville, 820 Prudential Drive, Suite 203, Howard Building, 32207, Jacksonville, FL, USA

Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, University of Florida HSC/Jacksonville, 820 Prudential Drive, Suite 203, Howard Building, 32207, Jacksonville, FL, USA

    Niranjan Kissoon

  2. The Hospital for Sick Children, Toronto, Ontario, Canada

    Desmond Bohn

Authors
  1. Niranjan Kissoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Desmond Bohn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Niranjan Kissoon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kissoon, N., Bohn, D. Choosing a volume expander in critical care medicine. Indian J Pediatr 70, 969–973 (2003). https://doi.org/10.1007/BF02723823

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02723823

Key words

Search

Navigation