Colloids in sepsis: evenly distributed molecules surrounded by uneven questions

Area of Science:

• Critical Care Medicine
• Pharmacology
• Nephrology

Background:

• Colloids are widely used for fluid resuscitation in intensive care units.
• The clinical benefit of colloids in specific scenarios like sepsis remains debated.
• Albumin and starches are common colloids with distinct safety and efficacy profiles.

Purpose of the Study:

• To conduct a narrative review on the safety and efficacy of colloids in sepsis and septic shock.
• To evaluate the evidence for albumin and starches in critically ill septic patients.
• To provide guidance on colloid use in sepsis based on current literature.

Main Methods:

• Narrative review of existing clinical trials and studies.
• Focus on safety and efficacy data for albumin and starches.
• Analysis of adverse events, mortality, and renal outcomes.

Main Results:

• Colloids effectively expand volume and improve hemodynamics, even with increased capillary permeability in sepsis.
• Starch use is linked to increased mortality, renal impairment, and higher need for renal replacement therapy in severe sepsis.
• Albumin is the only colloid demonstrated to be safe in sepsis and may benefit specific subpopulations, though routine use lacks robust evidence.

Conclusions:

• Most colloids, particularly starches, should not be routinely used in sepsis due to unproven benefits and potential harm.
• Albumin is safe for sepsis patients and may be considered in hypoalbuminemic cases, but routine administration is not supported by current data.
• Starch use in sepsis should be avoided pending further research due to significant safety concerns.