IntroductionIn recent times there has been considerable and continuous controversy over the risk factors associated with application of colloids to critically ill patients. Clinical studies have shown that there is considerable difference in the effects of colloids and crystalloids on a range of physiological parameters. This difference in effects has been clinically studied in the course of meta-analyses of mortality in randomized trials of critically ill patients applied with either colloids or crystalloids as comparative fluids applied for volume expansion. Nevertheless, at the very beginning of this analysis, it is noted that review of recent literature has revealed that, though such meta-analyses and other studies have revealed that colloid usage in the critically ill indicates higher than normal risk of mortality, affected physiological parameters are not universally defined nor has there been any progress towards emergence of any definite applications guidelines.
(Schierhout and Roberts, 1998) Since the particular colloid being investigated here is albumin some little is being said here about the colloid. Albumin is a synthetic colloid derived from pooled plasma collection and hence there is always the risk of infection.
Aside from this there are other reasons why the controversy over its and other colloids’ usage continues. These are as follows. They have a hitherto undefined potential for adverse effects. They are relatively costlier than crystalloids. There is a lack of consensus regarding their application. (American Thoracic Society Consensus Statement, 2004)The American Society Consensus Statement is a very comprehensive document on colloids and it has listed a number of adverse effects of colloid application with particular physiological explanations. This analysis believes that such information should be more forthcoming if the controversy is to be cleared once and for all.
In the light of that it is also noted that the analysis report includes in a synopsis some of the salient characteristics of albumin. This is because only by studying the chemistry of the colloid and its subsequent interaction with human physiology, both normal and diseased, can the exact mechanism or mechanisms of the adverse effects be unraveled. In this context not only the chemistry but also the genetics, which primarily initiates the chemistry, should be studied. Only the physiological chemistry is touched upon here in a rudimentary fashion.
No genetics is provided. Objectives of the Analysis: To quantitatively determine the effect on mortality of administering albumin or plasma protein fraction on critically ill patients. Albumin: The Colloid Albumin was the first natural colloid to be used clinically as a volume expander and it remains the standard colloid in comparison to other colloids being used clinically on critically ill patients. Colloids: Colloids are usually large molecules that do not pass through the thin capillary walls and they exert an oncotic pressure that restores fluid balance.
They are usually applied to restore intravascular volume and improve tissue perfusion. (Albumin, US Pharmacist, 2000)Clinical usage of albumin: Albumin is applied to increase intravascular oncotic pressure and expand intravascular volume in patients with hypovolemic shock, severe burn injury, adult respiratory distress syndrome (ARDS), ascites, liver failure and pancreatitis. It is also clinically applied to patients undergoing cardiopulmonary bypass. It is also sometimes used to treat neonatal hyperbilirubinemia, hypoproteinemia and nephritic syndrome. (Albumin, US Pharmacist, 2000). It is also noted at the very beginning that, at present, the usage of albumin in patients for the above purposes is under controversial analysis with the US Food and Drug Administration (FDA) strongly advising physicians to be discrete in the use of albumin (FDA, CBER, 1998).
It bases its cautious notice on the Cochrane Injuries Group report that shall be more comprehensively dealt with later in this analysis report. The FDA further cautions, as on that date, that physicians should wait till more research has been done on the adverse effects of albumin therapy and some positive decision has been reached upon its continued usage.