Albumin controversy continues : Meta-analysis has affected use of albumin

Editor—With the recent Cochrane Injuries Group meta-analysis regarding albumin1 and subsequent correspondence in mind, we undertook a postal survey of paediatric departments in the South East Thames region. We asked clinicians which fluid (crystalloid, albumin, or other colloid) would be used in a variety of scenarios, before and after 25 July 1998, in light of the meta-analysis. Altogether 12 of 13 departments replied, which equals a 92% response rate (table). We found that all 12 would use crystalloid for 5% dehydration after gastroenteritis, both before and after 25 July. Crystalloids are favoured over “other colloids” for all indications. Recent publications have influenced routine clinical practice, reducing clinicians’ willingness to use albumin, but most departments have not made changes. Only in trauma resuscitation has there been a substantial shift away from albumin to crystalloid, and in meningococcal disease clinicians are still regularly using albumin. This suggests that published reservations2 regarding the meta-analysis are borne out in clinical practice.