Colloid infusion in the trauma patient

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Big world of caution:

You will recall that in SAFE (New Engl J Med 2004, 350:2247-2256) the a priori trauma subgroup (17.3% of 7000 patients, making it the biggest ever trauma fluid study) showed evidence of harm when albumin was given to trauma patients. On subgroup analysis this harm appeared to be restricted to those with a traumatic brain injury. A 2 year followup of these TBI patients has been analysed and is about to be published and you should all look very closely at the results (I can't say more until it hits the press).

The other big message from SAFE is that the 3:1 colloid to crystalloid ratio that we are taught in books (which comes from healthy volunteer dogs in the 1950s) is utter rubbish when applied to sick humans. In every subgroup there was a consistent 1.4:1 ratio (volume of albumin conpared to volume of saline, to acheive a clinical resuscitation endpoint). This will creep into the books eventually.

For now I think it is fair to say that anyone who gives colloids to a trauma patient in ICU is being very unwise!

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Staff Specialist in Intensive Care Medicine
The Nepean Hospital, 
PO Box 63, Penrith NSW 2751
Clinical Lecturer, University of Sydney


>>> tangentcarrot at hotmail.com 10/23/05 01:24am >>>
Actually, niyher do us.
But it is available for use with patients who's transfer to the hospital is 
greatly delayed (not saying that it will be used in such a case, only that 
it's available. It's for doctor to decide, as much as I can recall it's not 
indicated by some protocol or something)

Do you use it with trauma patients in the ICU?



>From: flysurg at aol.com 
>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>To: trauma-list at trauma.org 
>Subject: Re: Colloid infusion in the trauma patient
>Date: Sat, 22 Oct 2005 11:07:43 -0400
>
>We NEVER use colloids in initial resuscitation, prehospital or otherwise. 
>The literature clearly does not support colloid use.
>
>Steve Smith
>
>-----Original Message-----
>From: oded private <tangentcarrot at hotmail.com>
>To: trauma-list at trauma.org 
>Sent: Fri, 21 Oct 2005 18:25:32 +0200
>Subject: Colloid infusion in the trauma patient
>
>
>Hello trauma list
>
>Lately, I have been dealing with the teaching of fluid ressuscitation in 
>trauma to EMT-B'S (not directly by teaching but by dealing with contents of 
>the class and consulting with instructors) and the subject of the use of 
>colloid solutions (under the doctor's order only. of course) came up, so 
>I'd like t o here from those of you who have had expreince with this 
>therapy (both in the pre-hospital and trauma-room settings) to share your 
>knowledge and experience with me- what solutions did use? does any of you 
>continue to practice this therapy? did you find it to have significant 
>adventages over using soley cristalloids? How did you avoid or manage its 
>complications and dangers?
>
>Looking forward to your respondes and wishing you a happy succot,
>Oded
>
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