Is colloid solution beneficial in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Given that third-spacing of intravascular fluid is a hallmark of septic shock, it makes sense that administration of colloid solution might be beneficial. However, although colloid resuscitation with albumin has not been shown in many meta-analyses to have any advantage over isotonic crystalloid resuscitation (isotonic sodium chloride solution or lactated Ringer solution) in this setting, [82] Delaney et al found adjunctive albumin resuscitation to provide a statistically significant mortality benefit in relation to other regimens. [83]

In the Saline versus Albumin Fluid Evaluation (SAFE) trial, in which about 1200 of 7000 ICU patients who required fluid resuscitation had at the time what was deemed severe sepsis, no overall difference between the 2 treatment groups was seen. [84] However, the investigators noted a trend toward improved outcome in patients with severe sepsis who received 4% albumin rather than normal saline. The data are inconclusive, especially with regard to the initial resuscitation phase for septic shock in the ED; therefore, crystalloid fluid resuscitation is recommended.


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