Tutorial 11: Albumin & Colloids

If you accept that the capillary glycocalyx is a real thing and that the Starling principle is fatally flawed – they you are going to have a real problem with the concept of colloid based fluid resuscitation. For many decades the argument for using large molecular weight compounds – emulsed in crystalloid – as a way of volume sparing resuscitation – versus the use of crystalloids alone – was a major topic of medical conferences and journals. I believe that the topic is currently closed in favor of crystalloids, for reasons that I will outline in the next two tutorials. But, what of albumin…..
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0:00 Beginning
01:10 Contents
01:20 Clinical Scenario (hypoalbuminemic patient with septic shock)
02:00 Albumin Physiology
08:45 Albumin and The Glycocalyx
09:50 Why Hyperoncotic (20%) Albumin Doesn't Mobilize Fluid
10:30 Albumin Distribution and Inflammation
11:40 Types of Patient Who May Benefit from Albumin Transfusion
12:20 Albumin and Bleeding
12:40 Albumin and Major Surgery
13:20 Albumin and Cirrhosis
15:40 Albumin and Sepsis (clinical scenario revisited)
19:50 Colloids
22:00 How Colloids are Supposed to Work
25:30 Complications of Colloid Therapy
26:30 Necessary Review of Evidence Relating to Colloids and Albumin
31:50 Does Albumin "Work" in Critical Illness
33:00 Review