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

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.