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Home > List Archives

Colloid infusion in the trauma patient

Tchaka Shepherd tshepherdmd at hotmail.com
Thu Oct 27 05:52:07 BST 2005


Very intriguing.  Can not wait to read the article.


>From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>To: <tangentcarrot at hotmail.com>, <trauma-list at trauma.org>
>Subject: Re: Colloid infusion in the trauma patient
>Date: Thu, 27 Oct 2005 11:56:11 +1000
>
>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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