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Use of Albumin in burns resuscitation

Richard Wigle MD FACS rlwigle at yahoo.com
Sat May 21 00:18:35 BST 2011


The classic use of albumin in burns is on day 2 of care when the capillary leaks are supposed to have closed. The cochrane review as far as I can tell refers to colloids in initial resuscitation. For a good review of initial care see the supplement to this months J of Trauma

R Wigle  MD FACS
LSU Shreveport

--- On Fri, 5/20/11, Nikahat Jahan <nikahat at gmail.com> wrote:

From: Nikahat Jahan <nikahat at gmail.com>
Subject: Use of Albumin in burns resuscitation
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Date: Friday, May 20, 2011, 12:55 PM

Dear all
There are several studies that recommend the use of colloids- 5% albumin in
burn resuscitation- esp after the first 24 hrs. The original Parkland
formula had included 5% albumin from day 2. Few other formulae like the
Muir-Barkley formula and Modified Brooke formula include colloids.

The most recent cochrane review also concludes that *" There is no evidence
from RCTs that resuscitation with colloids reduces the risk of death,
compared to resuscitation with crystalloids, in patients with trauma, burns
or following surgery. As colloids are not associated with an improvement in
survival, and as they are more expensive than crystalloids, it is hard to
see how their continued use in these patients can be justified outside the
context of RCTs."*

Cochrane Database Syst Rev. <http://www.ncbi.nlm.nih.gov/pubmed/21412866> 2011
Mar 16;3:CD000567.
Colloids versus crystalloids for fluid resuscitation in critically ill
patients.
Perel P<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Perel%20P%22%5BAuthor%5D>
, Roberts I<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20I%22%5BAuthor%5D>
.

In view of the phenomenon of "Fluid Creep" and studies that show that
colloids reduce it, what would be the right way to resuscitate patients with
extensive burns- to use 5% albumin or avoid it?

-- 
Lt Col Nikahat Jahan
Classified Spl (Anaesthesiology)
Indian Army
--
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