***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Hypertonic solutions effectively improve hemodynamic parameters in patients admitted to the emergency room . However , no significant differences in outcome were observed compared with st and ard isotonic treatment in most previously published studies . This study evaluates pretreatment prognostic factors that predict a beneficial effect of hypertonic solution in patients admitted to the emergency room with hemorrhagic hypovolemia in a prospect i ve double-blind fashion . The patients ( n = 212 ) were r and omized upon admission to receive 250 mL intravenous ( i.v . ) bolus of hypertonic 7.5 % NaCl + 6 % dextran ( HSD , n = 101 ) , or isotonic 0.9 % NaCl solutions ( IS , n = 111 ) as the first treatment , followed by st and ard resuscitation . Pretreatment factors assessed were sex , age , cause of hypovolemia , revised trauma score ( RTS ) , Glasgow index , and mean arterial pressure ( MAP ) on admission . Both groups were compared for survival at 24 h and 30 days postadmission . Infused volumes were registered . HSD administration significantly increased MAP and reduced i.v . crystalloid infusions to maintain hemodynamic parameters , compared with IS . There was no difference between groups in the number of blood transfusions administered . Overall complication rates in both groups were similar ( 24 % ) . There was a significant difference ( p < .03 ) in overall ( 30 days ) survival rate between HSD ( 73 % ) and IS ( 64 % ) groups . The 24 h survival rate was significantly lower in IS ( 72 % ) compared with HSD ( 87 % ) ; p < .01 . Multivariate analyses showed that RTS and MAP were identified as independent predictors for 24 h survival in the group that received HSD . When evaluated for overall survival rate , hypertonic infusion benefited significantly only patients with MAP < 70 mmHg ( p < .01 ) Patients with colorectal cancer undergoing elective surgery with resection of the tumour and primary anastomosis were r and omly allocated into two groups . 29 patients received a total of 60 - 75 g of albumin postoperatively , 30 patients received no albumin and served as controls . The two groups were comparable with respect to age and sex of the patients and stage of growth of the tumour . The patients who received albumin had a significantly lower preoperative serum albumin concentration . On day 4 after the operation the serum albumin concentrations of the control patients and the patients who received albumin were 20 % and 5 % lower , respectively , than the preoperative value . Eight patients of the albumin group and 5 of the control group developed postoperative complications . There was no significant difference in the postoperative clinical course between the two groups . Preoperative serum albumin levels did not differ between patients who developed postoperative complications and those who had an uneventful postoperative course whether or not they received albumin postoperatively . The present study does not confirm earlier results indicating that serum albumin alone is of prognostic value for the postoperative course following colorectal surgery . Furthermore , the postoperative course is not improved by addition of albumin postoperatively and hence albumin should be given in this situation only when its specific oncotic effect is required Hemodilution in the acute phase of ischemic stroke is still controversial . Multicenter studies have failed to demonstrate any benefit . The present study focuses attention on analysis of circulation in stroke and on individual restabilization of circulation . Methods The Amsterdam Stroke Study is a prospect i ve , single-center , r and omized clinical trial ( n=300 ) . Normovolemic hemodilution is accomplished in a customized procedure by administration of 20 % albumin plus crystalloids under hemodynamic and rheological monitoring in the acute phase of stroke . All patients receive general intensive care treatment and monitoring with a pulmonary artery catheter  . This custom-tailored fluid therapy is guided on the basis of a target pulmonary capillary wedge pressure ( 12±3 mm Hg ) and hematocrit ( 0.32±0.02 ) . The control group receives only customized rehydration by infusion of crystalloids . Results We obtained significant ( p<0.05 ) reduction in mortality at 3 months ( from 27 % to 16 % ) and an increase in independence at home ( from 35 % to 48 % ) after viscosity reduction by means of hemodilution with albumin in the subgroup with a hematocrit < 0.45 ( n=201 ) ( specific viscosity effect ) . We also obtained a significant ( p<0.005 ) reduction in mortality at 3 months ( from 27 % to 8 % ) and an increase in independence ( from 35 % to 59 % ) after only rehydration with crystalloids in the subgroup with overt dehydration ( hematocrit ≥0.45 ; n=51 ) as compared with the normal-hematocrit group without signs of dehydration ( hematocrit < 0.45 ; n=103 ) ( specific rehydration effect ) . Conclusions This study may provide an explanation for the failures in former hemodilution trials and may re-establish proper hemodilution and rehydration as a valuable therapy in the acute phase of stroke , thus reducing mortality and improving independence after 3 months To evaluate the use of hypertonic saline/dextran solutions in the prehospital resuscitation of severely injured patients , we administered 250 mL of either 7.5 % sodium chloride/dextran 70 ( HSD ) ( n = 83 ) or lactated Ringer 's solution ( n = 83 ) , followed by conventional isotonic fluids , to 166 trauma patients with systolic blood pressures less than or equal to 100 mm Hg , in a prospect i ve , r and omized , double-blinded clinical trial . Patients in the sodium chloride/dextran 70 group required less fluid before hospitalization and arrived in the emergency department with higher systolic blood pressures than patients in the lactated Ringer 's solution group . The rate of survival to hospital discharge for the entire cohort was 64 % for patients in the sodium chloride/dextran 70 group vs 59 % for patients in the lactated Ringer 's solution group . The rate of survival to hospital discharge for the patients with severe head injuries was 32 % for the sodium chloride/dextran 70 group vs 16 % for the lactated Ringer 's solution group . Actuarial survival for patients with severe head injuries in the sodium chloride/dextran 70 group compared with patients with severe head injuries in the lactated Ringer 's solution group did not quite reach statistical significance . There were no adverse side effects associated with sodium chloride/dextran 70 administration . Administration of small volumes of sodium chloride/dextran 70 before hospitalization increased the blood pressure of severely injured patients more effectively than did lactated Ringer 's solution and showed tendencies toward improving survival in the patients with severe head injuries The effect of decreased colloid oncotic pressure , as seen in hypoalbuminemia and hypoproteinemia , upon intestinal function has been well delineated in the surgical literature . Patients undergoing abdominal aortic aneurysm resection or aortoiliac or aortofemoral bypass grafts  are almost uniformly hypoalbuminemic postoperatively ; with these two facts in mind , a prospect i ve , r and omized clinical study was undertaken to identify the role of serum albumin concentration on the length of postoperative ileus in this population . The main hypothesis was that patients whose albumin levels dropped below 3.5 gm/dL would have a more prolonged postoperative hospital course as a result of delay in return of bowel function when compared with those patients in whom the low albumin levels were exogenously acutely replenished to > 3.5 gm/dL. Albumin was replaced to a level greater-than or equal to 3.5 g/dL in one group of 37 patients ( AR ) , with a control group of 32 patients ( NR ) not receiving any albumin . Return of bowel function was measured by the postoperative day that flatus was documented , as well as the postoperative day oral intake was resumed . Mean values were determined for each group , and t tests did not reveal a significant difference in postoperative day of flatus ( AR mean = 4.06 days , NR mean = 4.16 days ) or postoperative day of oral intake ( AR mean = 4.0 , NR mean = 3.75 ) . Additional comparisons between the groups involving the number of postoperative days until a regular diet was begun ( AR mean = 6.06 , NR mean = 5.48 ) and length of postoperative hospital stay ( AR mean = 9.16 , NR mean = 8.43 ) failed to reveal significant differences . ( ABSTRACT TRUNCATED AT 250 WORDS The IV administration of sodium chloride solutions may produce a metabolic acidosis and gastrointestinal dysfunction . We design ed this trial to determine whether , in elderly surgical patients , crystalloid and colloid solutions with a more physiologically balanced electrolyte formulation , such as Hartmann ’s solution and Hextend ® , can provide a superior metabolic environment and improved indices of organ perfusion when compared with saline-based fluids . Forty-seven elderly patients undergoing major surgery were r and omly allocated to one of two study groups . Patients in the Balanced Fluid group received an intraoperative fluid regimen that consisted of Hartmann ’s solution and 6 % hetastarch in balanced electrolyte and glucose injection ( Hextend ) . Patients in the Saline group were given 0.9 % sodium chloride solution and 6 % hetastarch in 0.9 % sodium chloride solution ( Hespan ® ) . Biochemical indices and acid-base balance were determined . Gastric tonometry was used as a reflection of splanchnic perfusion . Postoperative chloride levels demonstrated a larger increase in the Saline group than the Balanced Fluid group ( 9.8 vs 3.3 mmol/L , P = 0.0001 ) . Postoperative st and ard base excess showed a larger decline in the Saline group than the Balanced Fluid group ( −5.5 vs −0.9 mmol/L , P = 0.0001 ) . Two-thirds of patients in the Saline group , but none in the Balanced Fluid group , developed postoperative hyperchloremic metabolic acidosis ( P = 0.0001 ) . Gastric tonometry indicated a larger increase in the CO2 gap during surgery in the Saline group compared with the Balanced Fluid group ( 1.7 vs 0.9 kPa , P = 0.0394 ) . In this study , the use of balanced crystalloid and colloid solutions in elderly surgical patients prevented the development of hyperchloremic metabolic acidosis and result ed in improved gastric mucosal perfusion when compared with saline-based solutions We report the results of the first clinical study on the use of a hypertonic saline-dextran solution for the prehospital management of hypotensive victims of penetrating trauma . During a 4-month period , 48 trauma patients with penetrating injuries and a prehospital systolic blood pressure of 90 mm Hg or less were infused in-field with 250 ml of either a hypertonic saline-dextran solution or the crystalloid plasmalyte A. There were no complications associated with the infusion of the hypertonic saline-dextran solution , and execution of the protocol by paramedic personnel was both safe and uniformly successful . The potential impact of this solution on medical care and the results of this feasibility study justify the initiation of a larger prospect i ve , r and omized clinical trial on the efficacy of this solution in the prehospital setting OBJECTIVE To evaluate the volume used and the indications for use of the human albumin solutions , stable plasma protein solution and normal serum albumin , in Victorian metropolitan teaching hospitals . DESIGN The Victorian Drug Usage Advisory Committee conducted a prospect i ve audit by means of a question naire in three major Melbourne teaching hospitals over a three-month period . All bottles of the human albumin solutions issued were numbered and a question naire regarding indications for use was completed for each patient treated with either product . OUTCOME MEASURES The results were compared with the recommendations of the Australasian Society of Blood Transfusion to determine whether usage was appropriate , and the number of bottles used was analysed for each hospital and each major indication . RESULTS The survey was comprehensive ( 84 % of the forms were returned ) and demonstrated that these products are used for appropriate clinical categories , for example , hypovolaemia , hypoalbuminaemia , and not for inappropriate indications , such as nutritional support or wound healing . There was however a marked variation in the level of usage for a given indication between the three hospitals . CONCLUSIONS This variation reflected a considerable difference in unit policy regarding the use of these products in preference to crystalloid or synthetic colloid solutions . The variation suggests the need for more specific guidelines for the use of these products in defined clinical setting A prospect i ve , r and omized trial was performed to determine whether maintaining serum albumin levels in burned pediatric patients had any effect on morbidity and mortality .  Patients < 19 years of age with burns > 20 % total body surface area were r and omized to receive supplemental albumin to maintain levels 2.5 to 3.5 g/dL ( " High Albumin " ) or were given albumin only if levels dropped < 1.5 g/dL ( " Low Albumin " ) after completing burn shock resuscitation . The 36 patients in the Low Albumin group were well matched for age , burn size , depth of injury , and inhalation injury when compared with the High Albumin group ( 34 patients ) . As expected , serum albumin levels were significantly lower in the Low Albumin group when compared with the High Albumin group 
    Output:
    
There is no evidence from RCTs that resuscitation with colloids reduces the risk of death , compared to resuscitation with crystalloids , in patients with trauma , burns or following surgery .
As colloids are not associated with an improvement in survival , and as they are more expensive than crystalloids , it is hard to see how their continued use in these patients can be justified outside the context of RCTs