Current opinion in critical care
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Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials. ⋯ There is no evidence for an overall beneficial effect of HES in any subgroup of critically ill patients, but there are clear signs of harm. As safer alternatives exist, we recommend that HES is no longer used in critically ill patients.
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Fluid resuscitation is a common intervention in acute medical practice. The optimum fluid for resuscitation remains hotly debated and it is likely to vary from one clinical situation to another. Human albumin solutions have been available since the 1940s, but their use varies greatly around the world. This review examines the current evidence for and against the use of albumin as a resuscitation fluid. ⋯ Fluid resuscitation with albumin is well tolerated and produces similar results to resuscitation with saline. Albumin should be avoided in patients with traumatic brain injury; possible benefits in adults with severe sepsis remain to be confirmed.
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This review explores the contemporary definition of the term 'balanced crystalloid' and outlines optimal design features and their underlying rationale. ⋯ The case for balanced crystalloids is growing but unproven. A large randomized controlled trial of balanced crystalloids versus 0.9% sodium chloride is the next step.
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This review summarizes the current evidence base for commonly transfused blood components with a particular focus on the nonacutely bleeding patient. ⋯ As all blood components have some level of risk, the general approach to transfusion should be one of minimization. For the nonacutely bleeding critically ill patient, a RBC transfusion trigger of 70 g/l is clinically acceptable. For patients at potentially higher risk of adverse effects related to anemia such as those with septic shock, severe and/or acute ischemic heart disease, or brain injury, a higher threshold (80-90 g/l) may be considered. There is insufficient evidence to recommend specific thresholds for transfusion of frozen plasma or platelets in the critically ill.