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Preferred plasma volume expanders for critically ill patients: results of an international survey

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Abstract

Objective

Criteria for plasma volume expander selection in critically ill patients remain controversial. This study evaluated preferences of intensivists regarding plasma volume expanders.

Design

International survey using a 75-item questionnaire.

Participants and setting

All members of the European and French Societies of Intensive Care Medicine (n=2,415 in 1,610 adult ICUs in Europe and elsewhere) were invited to participate, and 577 (24%) working in 515 ICUs (32%) returned completed questionnaires.

Results

Among respondents, 17% used crystalloids alone as their first-choice strategy, 18% colloids alone, and 65% both. Colloids alone were often chosen in patients with cirrhosis (42%), coagulation disorders (42%), or adult respiratory distress syndrome (39%); and crystalloids in patients with dehydration (85%), drug overdose (59%), or acute renal failure (49%). First-line plasma expanders were as follows: isotonic crystalloids (81%), starches (55%), gelatins (35%), albumin (7%), plasma (6%), dextrans (4%), and hypertonic crystalloids (2%). Colloids alone were used more frequently in the United Kingdom (40%), starches in Germany (81%) and The Netherlands (66%), and gelatins in the United Kingdom (68%). The main factors behind preferences for first-line plasma volume expanders were time to volume loss correction, duration of effect, adverse events, and cost.

Conclusions

Colloids are widely used as first-line treatment, usually in combination with crystalloids. Starches are the most widely used colloids in Europe, where albumin use is declining. However, strategies vary widely across clinical situations and countries.

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Acknowledgements

We thank the European Society of Intensive Care Medicine and the French Society of Intensive Care Medicine (Société de Réanimation de Langue Française) for providing the databases used to identify the study participants and Sophie Jacques-Weber for her secretarial assistance throughout the survey.

Author information

Authors and Affiliations

  1. Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, 75018, Paris, France

    Frédérique Schortgen

  2. Medical Intensive Care Unit, Henri Mondor Teaching Hospital, 94000, Créteil, France

    Nicolas Deye & Laurent Brochard

Authors
  1. Frédérique Schortgen
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  2. Nicolas Deye
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  3. Laurent Brochard
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Consortia

for the CRYCO Study Group

Corresponding author

Correspondence to Frédérique Schortgen.

Additional information

This study was presented in part at the 15th Annual Congress of the European Society of Intensive Care Medicine, Barcelona, 29 September–2 October 2002. This study was supported by grant Projet Hospitalier de Recherche Clinique AOM00120 from the Assistance Publique-Hôpitaux de Paris (Paris Teaching Hospital Network).

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Schortgen, F., Deye, N., Brochard, L. et al. Preferred plasma volume expanders for critically ill patients: results of an international survey. Intensive Care Med 30, 2222–2229 (2004). https://doi.org/10.1007/s00134-004-2415-1

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  • DOI: https://doi.org/10.1007/s00134-004-2415-1

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