Systematic Reviews: Clinical Scenario
The patient is a 46 year old male who is admitted with alcohol induced pancreatitis. His past medical history is significant for alcoholic cirrhosis and 40 pack years of smoking. The patient is admitted from the emergency department with a systolic blood pressure of 60 mm HG. He has no evidence of bleeding but is febrile. An abdominal CT scan is suspicious for infected pancreatic necrosis and he is taken to the operating room for debridement. The intraoperative cultures of the pancreatic fluid show gram negative rods. He was admitted to the ICU with a blood pressure of 70 mm hg. He had a profound capillary leak as evidenced by peripheral edema and his pulmonary artery catheter suggested hypovolemia. His albumin was 1.7 gm/dl. The patient's surgeon suggested that you give the patient 5% albumin as a resuscitative fluid because the patient was hypoalbumenic. You stated that several recent systematic reviews suggest that the use of colloids may by associated with increased mortality in critically ill patients who are hypovolemic . You formulate the question, 'In a critically ill patient with hypovolemia, does the use of colloids increase the risk of death compared to crystalloids?'
You search the Medline using the terms 'albumin' and 'hypovolemia' to identify the Cochrane Review that you remember hearing about. You find the appropriate citation in the BMJ.
Read the article and decide:
- Is the evidence from this systematic review valid?
- Is this valid evidence from the systematic review important?
- Can you apply this valid and important evidence from this systematic review in caring for your patients.