For "big" cases I use plasmalyte as my crystalloid but switch to albumin early if I need it.
Sean Funston Sent from my iPhone On Jan 28, 2014, at 11:51 AM, "Kramer, George C." <[email protected]<mailto:[email protected]>> wrote: Donna, A perspective of a physiologist (with an attitude) :) One to three is the classic ratio and probably good to use for equivalent volume expansion of colloid to crystalloid. But crystalloid expansion is quite transient and colloids are more sustained. This is both good and bad depending on concerns about volume overload. I would say that for clinical use 6% albumin and most starches are similar as to volume expansion. I believe our clinicians use LR first and only go to albumin when LR is not effective and they don't use any fixed rules. Also, I believe they prefer LR over NS due to hypercholremic acidosis with large volume loads. I would say that plasmalyte is best crystalloid, but I don't see that it is used here much. At our institution, in ICU and OR it is almost always albumin as the colloids and ratios of 1/2 or 1/3 are typically used. I think there is strong evidence developing about the dangers and limitations of starches due to renal complications. I have cc'ed our top docs and they may weigh in. George, George Kramer, PhD Resuscitation Research Lab Dept. of Anesthesiology UTMB, Galveston 409-939-3040 From: <Hixson>, Donna <[email protected]<mailto:[email protected]>> Date: Tuesday, January 28, 2014 11:00 AM To: "'[email protected]<mailto:'[email protected]>'" <[email protected]<mailto:[email protected]>> Subject: [Sepsis Groups] Albumin & Hetastarches Is there a new conversion list for the hetastarch and albumin fluid amounts? Is it safe to say since the colloids are increased by 1/3 the other fluids should follow? <image003.jpg> With Regards, Donna Hixson R.N. Research Outcomes Nurse Vascular Registry [email protected]<mailto:[email protected]> Office (727) 462-7615 Fax (727) 462-3638 MS 73 Confidential: This electronic message and all contents contain information from BayCare Health System which may be privileged, confidential or otherwise protected from disclosure. The information is intended to be for the addressee only. If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender and destroy the original message and all copies. <image003.jpg>
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