USE OF ALBUMIN AND OTHER PLASMA SUBSTITUT ES FROM 1989 TO 1993 IN A FRENCH UNIVERSITY HOSPITAL

Objectives: To evaluate the nse of plasma substitutes (albumin, gelati ns, dextrans, starches) from 1989 to 1993 in a 3000-bed University hos pital and to assess the impact of the 1989 consensus conference of the French speaking Society of Intensive Care Medicine on the choice of p lasma substitutes for treatment of hypovolaemia. Study design: Retrosp ective study of a case series. Methods: Data on the use of albumin and artificial plasma substitutes were obtained from Blood Bank and Pharm acy. Results: Between 1989 and 1993, the total amount of administered plasma substitutes decreased by 20%, allowing a saving of 1.7 million FF. There was a 60% decrease in the use of gelatins and dextrans. The starches, introduced in 1991, became in 1993 the most used plasma subs titute, with 37% of the total. The use of albumin showed only a 32% de crease and was still in 1993 the main source of expenditure for plasma substitutes, with 3.8 million FF and 80% of the total cost. The numbe r of plasmapheresis increased by 15%, whereas the use of albumin for p lasmapheresis, almost constant in absolute value, increased from 31% i n 1989 to 45% in 1993 of the total expenses. There were large differen ces between the services regarding the use of albumin. Intensive care and surgical units represented 70% of the total (plasmapheresis exclud ed). In this group, the overall fall of use was 22%, some units obtain ing a 93% decrease whereas other did not change in spite of constant a dmission numbers. Medical units decreased their albumin use by 53%. Co nclusion: The decrease in the albumin use between 1989 and 1993 was no t significant. The impact of the consensus conference, if any, was wea k. A careful evaluation of the prescriptions would be necessary to imp rove the compliance of clinical practice with recommendations by the c onsensus conference.