ViewpointAlbumin and hypovolaemia: is the Cochrane evidence to be trusted?
Section snippets
The Cochrane Review hypovolaemia group
The studies assigned to the hypovalaemia group consisted of 13 randomised studies in which the relative risk of death from each was assessed and the results pooled. If the relative risk was less than 1·0, it favoured the intervention group, and if it was more than 1·0, it favoured the control group, which received either lactated Ringer's solution or 0·9% saline. Seven of the studies had a relative risk of more than 1·0, and the pooled relative risk of all the results was 1·46. The reviewers
Grundmann and meyers5
This was a study involving 20 patients undergoing elective partial gastrectomy, which the reviewers accepted as a critical illness. The albumin (concentration unspecified but presumably hyperoncotic) was given for the first 4 postoperative days and was supplemental to larger infusions of crystalloids than those given in the control group. As its title makes clear, the albumin was given to determine its effect on colloid oncotic pressure. The single death in the albumin group was due to
Lowe and colleagues14
This study was inaccurately summarised in the review: the total numbers and the concentration of albumin were incorrect. It was a randomised trial of 141 patients (not 171 as written in the review)admitted for abdominal wounds from knives and guns who were given 3·6%(not 25%)albumin during resuscitation and surgery, which averaged 10 h. Two patients in each group died during surgery, and one each in the control and albumin groups subsequently died on the third and fourth days, respectively. The
Discussion
Meta-analysis of randomised controlled studies is generally accepted as being the most reliable way of determining clinical practice. This situation is true only if the evidence is robust enough to withstand critical peer review. McClelland,16 one of the peer reviewers on the Cochrane Injuries Group and the editor of the Handbook of Transfusion Medicine, described the members of the Cochrane Review as experts in sifting clinical evidence, and wrote that what they did was within the competence
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