February 27, 1995

A Paradigm for ConsensusThe University Hospital Consortium Guidelines for the Use of Albumin, Nonprotein Colloid, and Crystalloid Solutions

Author Affiliations

Vanderbilt University Hospital and Clinic, Nashville, Tenn; University of North Carolina Hospitals, Chapel Hill; Oregon Health Sciences University Hospital and Clinics, Portland; University Hospital Consortium, Oak Brook, Ill; University of Minnesota Hospital and Clinic, Minneapolis; The University Hospital of Arkansas, Little Rock; University of Arizona, Tucson; State University of New York University Hospital—Stony Brook; Indiana University Medical Center, Indianapolis; State University New York Health Science Center—Syracuse; University of Kentucky Hospital, Lexington; The Medical Center, University of California—San Francisco; Stanford (Calif) University Hospital; The University of Medicine and Dentistry of New Jersey, Newark; University of Wisconsin Hospital and Clinics, Madison; University Medical Center of Eastern Carolina—Pitt County, Greenville, NC; Pennsylvania State University Milton S. Hershey Medical Center, Hershey; University of Massachusetts Medical Center, Worcester; University Medical Center Corporation, Tucson, Ariz; University of Alabama Hospital, Birmingham; University of Texas Medical Branch—Galveston; University of Nebraska Medical Center, Omaha.

From the Center for Drug Policy and Clinical Economics, University of Wisconsin Hospital and Clinic, Madison (Mr Vermeulen), Technology Assessment Program, Technology Advancement Center, University Hospital Consortium, Oak Brook, Ill (Mr Matuszewski and Dr Ratko), Department of Pharmacy Practice, College of Pharmacy, University of Arizona, Tucson (Dr Erstad), and Transfusion Medicine Service, University of North Carolina Hospitals, Chapel Hill (Dr Brecher). A complete listing of the members of the University Hospital Consortium can be found in the acknowledgment section.

Arch Intern Med. 1995;155(4):373-379. doi:10.1001/archinte.1995.00430040041005

Objective:  To develop contemporary, comprehensive guidelines for the appropriate and efficient use of albumin, nonprotein colloid, and crystalloid solutions.

Design:  A systematic, literature-based, consensus exercise employing a modified Delphi method.

Participants:  Thirty-one medical and allied health professionals from 26 University Hospital Consortium (Oak Brook, Ill) member institutions were initially chosen to participate. Participants were selected on the basis of their recognized research in the use of albumin, nonprotein colloid, and crystalloid solutions, and/or experience in the review of appropriateness of such use. A total of 24 participants completed the

Main Outcome Measures:  Group responses were statistically analyzed in an iterative consensus development process. Five separate questionnaire rounds were designed to establish criteria for the appropriate use of albumin, nonprotein colloid, and crystalloid solutions.

Results:  Consensus guidelines were developed outlining the appropriate use of these products for 12 clinical indications, including hemorrhagic shock, nonhemorrhagic (maldistributive) shock, hepatic resection, thermal injury, cerebral ischemia, nutritional intervention, cardiac surgery, hyperbilirubinemia of the newborn, cirrhosis and paracentesis, nephrotic syndrome, organ transplantation, and plasmapheresis.

Conclusions:  The Delphi method, a systematic, literature-based consensus process, was shown to be useful in the development of complex clinical practice guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. It is anticipated that the guidelines will assist health care providers to develop local institutional policies and procedures for the appropriate and efficient use of albumin and albumin alternatives. Institutions reviewing and updating existing local guidelines may use the University Hospital Consortium guidelines as a model for comparison.(Arch Intern Med. 1995;155:373-379)