Influences on physicians' choices of intravenous colloids.
Miletin MS, Stewart TE, Norton PG.
Intensive Care Med 2002 Jul;28(7):917-24
Department of Medicine, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5.
AbstractOBJECTIVES. Controversy over the optimal intravenous fluid for volume resuscitation continues unabated. Our objectives were to characterize the demographics of physicians who prescribe intravenous colloids and determine factors that enter into their decision to choose a colloid.DESIGN. Questionnaire with 61 items.PARTICIPANTS AND SETTING. Ten percent ( n=364) of frequent intravenous fluid prescribers in the province of Ontario, Canada.RESULTS. The response rate was 74%. Colloid use in the past year was reported by 79% of the responding physicians. Important reasons for choosing a colloid included blood loss and manipulation of oncotic pressure. Physicians tended to prefer either albumin or pentastarch, but no important reasons were found for choosing between the two. Albumin with or without crystalloid was preferred in 5/13 scenarios by more than 50% of the respondents, whereas pentastarch was not favored by more than 50% of respondents in any scenario. Physicians practising in critical care areas and teaching hospitals generally preferred pentastarch to albumin. Physicians reporting pentastarch as representing greater than 90% of total colloid use were more likely to have been visited by a drug detailer for pentastarch than those who used less synthetic colloid (54 vs 22%, p<0.001).CONCLUSIONS. The majority of physicians surveyed prescribe colloid products and the reported use of albumin and pentastarch has a bimodal distribution. Although albumin appeared to be preferred in more clinical niches, most physicians did not state reasons for choosing between products. Marketing, specialty, location of practice and clinical scenario appear to play significant roles in the utilization of colloid products.