[Albumin and artificial colloids for massive bleeding]

Rapid and massive bleeding has to be counteracted by efficient volume restoration against rapid loss of intravascular volume. There are two phases of volume management for massive bleeding, uncontrolled phase and controlled phase. During initial uncontrolled phase, rapid infusion of crystalloid with RCC (red cell concentrate) is the first choice of volume management to prevent shock and profound decline of hemoglobin level. After shifting to the next controlled phase, artificial colloids and RCC become the next choice for efficient volume restoration. Although albumin has not been proven to improve prognosis in clinical studies, anti-inflammatory effect could be expected. Albumin infusion may be followed in this phase, and also albumin concentrate may be beneficial to reduce subsequent tissue edema due to massive infusion of crystalloid and artificial colloid. A new generation of hydroxyethyl starch is a promising blood substitute, designed with minimum side effect. Although renal damage especially in septic patient and coagulation disorder are theoretically suspected, beneficial effect as volume expansion overwhelms these stochastic side effects. Since the side effect depends on the dose and how much it remains in the body, a purposeful use during volume expansion phase should be recommended.