Colloid solutions have been extensively used during resuscitation of shock patients. They were often selected over crystalloid solutions because of their expected ability to expand plasma volume faster than crystalloids and at a lower volume. Recent data from high quality trials have questioned the superior efficacy of colloids over crystalloids and shown clear side-effects of colloids in critically ill patients. Thus hydroxyethyl starch has been shown to increase the risk of kidney failure, bleeding and mortality in critically ill patients. Albumin has been associated with increased mortality in patients with traumatic brain injury. Therefore, current guidelines do not recommend choosing colloids over crystalloids. In spite of this, there appears to be a continued use of albumin solutions in intensive care patients. The reasons for this are unknown. It may be that clinicians still believe in the colloid theory, a belief that made be supported by observations of the albumin trials in intensive care patients, including small differences in potency and results of sub-group analyses. However, albumin is a limited and expensive resource and its use is not supported by high-quality data.

1. Are colloids dead?
University of
Copenhagen
Anders Perner

2. University of
Copenhagen
COIs
Research funds from Fresenius Kabi, CSL Behring

3. Royal North Shore Hospital - Sydney

4. 6STRIAL

7. German starch

8. Are colloids dead?
NO

9. FENICE 2013
1st fluid challenge in 2213
patients in 311 ICUs in 43
countries
M Cecconi et al. ICM 2015; in press

10. FENICE 2013
1st fluid challenge in 2213
patients in 311 ICUs in 43
countries
25% colloids
M Cecconi et al. ICM 2015; in press

11. Colloid use in ANZ ICUs
N Hammond et al. ICM 2015; e-pub

12. …and in my ICU

13. Fluid purchase in 6 Danish hospitals

14. …adding Saline

15. Should colloids be
dead?

16. Crystalloids
Saline
Ringer’s
Hartman’s

17. Crystalloids Colloids
Starch
Gelatin
Dextran
Albumin
Saline
Ringer’s
Hartman’s

18. Are colloids effective?

19. Ratio
SAFE NaCl vs 4% albumin n=7000 1.4
CHEST NaCl vs 6% HES130 n=7000 1.2
6S trial Ringer vs 6% HES130 n= 800 1.1
CRYSTMAS NaCl vs 6% HES130 n= 196 1.0
Crystalloid to colloid volume ratio in blinded trials

20. Limited hemodynamic
differences

22. Albumin - mortality

23. Starch - mortality

26. Trauma - mortality
Perner et al AAS 2015

27. Harm from 4% albumin in TBI
J Myburgh et al NEJM 2007

28. Burn injury - mortality
Perner et al AAS 2015

29. No benefit from albumin in
sepsis

30. Crystalloids recommended in
guidelines

31. Crystalloids recommended in
guidelines

32. Crystalloids recommended in
guidelines

33. Crystalloids recommended in
guidelines

34. Crystalloids Colloids
Starch
Gelatin
Dextran
Albumin
Saline
Ringer’s
Hartman’s

35. No high-quality data support the use of colloids

36. Colloids are deadly wounded

37. University of
Copenhagen