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Role of albumin, starches and gelatins versus crystalloids in volume resuscitation of critically ill patients

Zazzeron, Luca; Gattinoni, Luciano; Caironi, Pietro

Current Opinion in Critical Care: October 2016 - Volume 22 - Issue 5 - p 428–436
doi: 10.1097/MCC.0000000000000341
CARDIOVASCULAR SYSTEM: Edited by Keith R. Walley

Purpose of review The review focuses on fluid resuscitation of critically ill patients with either colloid or crystalloid solutions.

Recent findings In healthy patients, the volume expanding effect of colloids is greater than that of crystalloids. However, in critically ill patients, a similar amount of crystalloids and colloids is required for fluid resuscitation, suggesting a lower efficiency of colloids when capillary permeability is increased, and endothelial glycocalyx disrupted. Recent studies on synthetic colloids in surgical patients confirmed the increased risk of renal failure reported in large clinical trials performed in critically ill patients. Experimental studies suggest that albumin maintains plasma volume expansion efficiency even when the capillary permeability is impaired, and that extravasation of albumin to the interstitium is lower than that of hydroxyethyl starch.

Summary Fluid administration should be tailored to patient characteristics. Synthetic colloids should be avoided when possible, especially in patients at risk for kidney injury. In critically ill patients with suspected increased permeability, colloids may not be superior to crystalloids in expanding plasma volume. Albumin appears to be less harmful than synthetic colloids, although its beneficial effects need to be further investigated. The endothelial glycocalyx layer is the key structure finely regulating intravascular fluid distribution.

aDipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy

bDepartment of Anesthesiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany

cDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy

Correspondence to Pietro Caironi, MD, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy. Tel: +39 02 5503 3232/3231; fax: +39 02 55033230; e-mail: pietro.caironi@unimi.it

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