Kongsgaard U E, Holtan A, Perner A
Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Medical Faculty, University of Oslo, Oslo, Norway.
Acta Anaesthesiol Scand. 2018 Apr;62(4):522-530. doi: 10.1111/aas.13057. Epub 2018 Jan 7.
Administration of resuscitation fluid is a common intervention in the treatment of critically ill patients, but the right choice of fluid is still a matter of debate. Changes in medical practice are based on new evidence and guidelines as well as traditions and personal preferences. Official warnings against the use of hydroxyl-ethyl-starch (HES) solutions have been issued. Nordic guidelines have issued several strong recommendations favouring crystalloids over colloids in all patient groups. Our objective was to describe the patterns of colloid use in Nordic countries from 2012 to 2016.
The data were obtained from companies that provide pharmaceutical statistics in different countries. The data are sales figures from pharmaceutical companies to pharmacies and health institutions.
We found a 56% reduction in the total sales of all colloids in Nordic countries over a 5-year period. These findings were mainly related to a 92% reduction in the sales of HES solutions. A reduction in sales of other synthetic colloids has also occurred. During the same period, we found a 46% increase in albumin sales, but these numbers varied between Nordic countries.
The general reduction in colloid sales likely reflects the recommendation that colloids should be used only in special circumstances. The dramatic reduction in the sales of HES solutions was expected given evidence of harm and the official warnings. The steady increase in albumin sales and the notable differences between the five Nordic countries cannot be explained.
给予复苏液体是危重症患者治疗中的常见干预措施，但液体的正确选择仍存在争议。医疗实践的变化基于新证据、指南以及传统和个人偏好。已发布了关于禁止使用羟乙基淀粉（HES）溶液的官方警告。北欧指南发布了多项强烈建议，在所有患者群体中更倾向于使用晶体液而非胶体液。我们的目的是描述2012年至2016年北欧国家胶体液的使用模式。
数据来自提供不同国家药品统计数据的公司。数据为制药公司向药店和医疗机构的销售数字。
我们发现北欧国家所有胶体液的总销售额在5年期间下降了56%。这些发现主要与HES溶液销售额下降92%有关。其他合成胶体液的销售额也有所下降。在同一时期，我们发现白蛋白销售额增长了46%，但这些数字在北欧国家之间有所不同。
胶体液销售额的总体下降可能反映了仅在特殊情况下才应使用胶体液的建议。鉴于有害证据和官方警告，HES溶液销售额的大幅下降在意料之中。白蛋白销售额的稳步增长以及北欧五个国家之间的显著差异无法解释。
