Anaesth Intensive Care 2010; 38: 266-273

International albumin use: 1995 to 2006

D. Jones*, S. McEvoy†, T. M. Merz‡, A. Higgins§, R. Bellomo**, J. D. Cooper††,
S. Hollis‡‡, C. McArthur§§, J. A. Myburgh***, C. Taylor†††, B. Liu‡‡‡, R. Norton§§§,
S. Finfer****
Critical Care and Trauma Division, The George Institute for International Health, Sydney, New South Wales, Australia

Summary
Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid
resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document
albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006.
Data on national albumin and synthetic colloid use was sought from independent intensive care researchers and
albumin issuers. The mass of albumin supplied per 10,000 persons on an annual basis by country and aggregated
across the study countries was calculated. Volumes of synthetic colloid supplied per 10,000 persons were calculated.
Data were obtained for 15 countries. Albumin use varied significantly between countries and throughout the
observation period. Overall, aggregate albumin use decreased from a peak of 2.54 kg per 10,000 persons in 1995 to
1.40 kg per 10,000 persons in 1999; use has remained relatively constant since. Data on supply of synthetic
colloids was available in only three countries and varied from 11.7 litres per 10,000 persons in Canada in 1995,
to 231.8 litres per 10,000 persons in Denmark in 2004. Between 1995 and 1999 albumin use decreased and has
been materially constant since; where data were available, use of synthetic colloids increased. Whether these
practice changes have resulted in a net health gain or in harm requires further research.
Key Words: albumin, synthetic colloid, fluid resuscitation, international drug utilisation review

Administration of intravenous fluids to maintain
or expand intravascular volume is one of the
common interventions in pre-hospital and hospital
medicine. Despite the widespread use of fluids,
especially in intensive care patients, there is ongoing
controversy over the type of fluid that should be
given1. Available data suggest that there is wide
* B.Sc. (Hons), M.B., B.S., F.R.A.C.P., Research Fellow, Monash
University., Melbourne, Victoria.
† M.B., B.S. (Hons), M.App.Epid., Ph.D., F.A.F.P.H.M., Senior Research
Fellow.
‡ M.D., Senior Staff Specialist, Department of Intensive Care Medicine,
Inselspital, Bern University Hospital and University of Bern, Bern,
Switzerland.
§ B.Physio (Hons)., M.P.H., Research Fellow, Monash University,
Melbourne, Victoria.
** M.B., B.S. (Hons), M.D., F.R.A.C.P., F.C.C.P., Professor, University of
Melbourne, Melbourne, Victoria.
†† B.M., B.S. (Flinders), M.D. (Adel), F.R.A.C.P., F.F.A.R.A.C.S.,
F.A.N.Z.C.A., Professor, Monash University, Melbourne, Victoria.
‡‡ B.Sc., B.Ed., M.Med.Sc., Research Fellow.
§§ M.B., Ch.B., F.A.N.Z.C.A., F.J.F.I.C.M., Clinical Director, Department
of Critical Care Medicine, Auckland City Hospital, Auckland, New
Zealand.
*** M.B., B.Ch., Ph.D., F.C.I.C.M., Director.
††† B.Ph.Ed., M.N.D., Research Fellow.
‡‡‡ M.B., B.S., M.P.H., D.Phil., Senior Research Fellow.
§§§ M.P.H., Ph.D., Principal Director.
**** M.B., B.S., F.R.C.P., F.C.I.C.M., F.R.C.A., Director.
Address for correspondence: Professor S. Finfer, PO Box M201,
Missenden Road, Camperdown, NSW 2050. Email: sfinfer@george.org.au
Accepted for publication on August 13, 2009.
variation in the type of fluids clinicians use. In a
survey of more than 2400 doctors in European
countries, 65% of clinicians reported using a
mixture of crystalloids and colloids for volume
resuscitation, isotonic crystalloids, hydroxy-ethyl
starches (HES) and gelatins being the most common
fluids used2. In contrast, in a survey of 364
clinicians in the Canadian province of Ontario in
1998 to 1999, respondents used predominantly
crystalloids for volume expansion; albumin was
the most commonly used colloid3. Other surveys
confirm significant practice variations and suggest
that uncertainty over the choice of fluids remains
widespread4,5.
Little is known about the reasons for heterogeneity
in regard to the choice of fluids for intravascular
volume expansion. Factors reported to influence the
choice of intravenous fluid include local policies,
costs, marketing pressure and published evidence
on beneficial or deleterious effects of a specific fluid
type2,3. As most data on choice of fluids originate
from surveys or point-prevalence studies, it is difficult
to assess if these factors have resulted in a change of
practice over time.
Human albumin has often been at the heart of
the debate on use of different intravenous fluid
solutions6,7. In 1998, the Cochrane Injuries Group
Albumin Reviewers published a meta-analysis of 30
Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
 International albumin use: 1995 to 2006
randomised controlled trials involving 1419 patients
to quantify the effect of fluids containing human
albumin on mortality in critically ill patients with
hypovolaemia, burns or hypoproteinaemia8. The
investigators included trials in adults, children and
neonates and concluded that administration of
albumin-containing fluids resulted in a 6% absolute
increase in the risk of death8. In May 2004, the
Saline versus Albumin Fluid Evaluation (SAFE)
Study investigators reported the first large-scale
randomised controlled trial to examine the effect of
type of resuscitation fluid on mortality9. The study,
involving 6997 critically ill adult patients, found
that use of either 4% albumin or normal saline
for fluid resuscitation resulted in similar 28-day
mortality. However, the SAFE investigators and
an accompanying editorial noted that further study
was needed to determine whether albumin or
saline conferred benefit in certain sub-populations
of critically ill patients1,9. Subsequently, the same
investigators have confirmed that resuscitation
with albumin increased mortality in patients with
traumatic brain injury10. Immediately following the
1998 meta-analysis, albumin use in England, Wales,
Scotland and Northern Ireland fell by at least 40%11:
whether the publication had a similar effect in other
parts of the world is not known.
In recent years the suggestion has emerged that
the choice of resuscitation fluid and especially the
use of HES might increase the risk of renal failure,
particularly in patients with severe sepsis. An
increased incidence of renal failure and oliguria in
intensive care unit patients with severe sepsis and
septic shock who received HES as resuscitation
fluid was reported by Schortgen et al in 200112.
In the following years the association between
occurrence of renal failure and use of a specific
fluid has been debated13,14. Recently, Brunkhorst
and colleagues reported that fluid resuscitation
with HES increased the incidence of acute renal
failure when compared with fluid resuscitation with
modified Ringers lactate solution15.
Given the central role of albumin in this
controversy, we sought to determine trends in the
use of albumin in a number of countries during
the last decade and where possible we report trends
in synthetic colloid use for comparison.
MATERIALS AND METHODS
Data sources for albumin use
Data on the annual albumin use between 1995 and
2006 were collected from 13 sources representing
15 countries (Australia, Canada, Denmark, England
Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
267
and Wales, Finland, France, Germany, Iceland,
New Zealand, Norway, Scotland and Northern
Ireland, Sweden and Switzerland). These sources
were able to supply data on the amount of albumin
issued to hospitals and we make the assumption
that any difference between the amounts of albumin
supplied to hospitals and the amounts administered
to patients is minimal. Data from Australia, New
Zealand and Canada were provided by the respective
national blood services (Australian Red Cross
Blood Service, New Zealand Blood Service and
Canadian Blood Service). In Europe, data for
Denmark were obtained from Laegemiddelstyrelse
(the Danish Drug Administration Agency); for
England and Wales combined from BPL Limited;
for Finland from the National Registry of Drug Use;
for France from the Groupement pour l’élaboration
et la réalisation des statistiques; for Germany from
the Paul Ehrlich Institute; for Iceland from the
Icelandic Medicines Control Agency; for Norway
from Octapharm; for Scotland and Northern Ireland
combined from the Scottish Blood Transfusion
Service; for Sweden from the Apoteket (Swedish
Drug Administration Agency); and for Switzerland
from the Swiss Agency for Therapeutic Products
and from individual companies licensed to supply
albumin in Switzerland. We also approached USA-
based authors of investigator-initiated studies in the
field of resuscitation fluid to seek data on national
albumin use in the USA.
Albumin use by country
Information on annual albumin use was provided
either by number of units and concentration (4%,
5%, 20% or 25%) or by total amount in kilograms.
Annual data on the total amount of albumin used
by jurisdiction was standardised by converting all
data to kilograms of albumin used per year. For
comparison of infusion volumes of albumin and
synthetic colloids, volume of synthetic colloid
was converted to “5% albumin equivalents” based
on published intravascular volume expansion
properties16-18. We also documented whether data
were provided by calendar year or financial year. In
the latter case, data are shown by year-end to
represent completed use (for example, for the
financial year 2000/2001, total is shown in 2001).
Data sources for synthetic colloid use
Data on annual synthetic colloid use between
1995 and 2006 were available for Denmark
(Laegemiddelstyrelse [the Danish Drug
Administration Agency]), Sweden (Apoteket
[Swedish Drug Administration Agency]) and
268 D. Jones, S. McEvoy et al

Canada (Canadian Blood Service), whereas in other
countries reliable sources could not be identified.
Synthetic colloid use by country
Information on annual use of synthetic colloids
was provided by number of units and concentration.
Annual data on the total amount of synthetic colloids
used was standardised by converting all data to
kilograms of dry weight colloid used per year. Due
to the different intravascular volume expansion
properties of specific fluids, volume equivalents to
the intravascular volume expansion of 5% albumin
were calculated (referred to as albumin volume
equivalents). According to published data we
defined the volume expansion of 5% albumin to be
equivalent to 6% HES or 4% gelatin solution,
whereas for 6% dextran a conversion factor of
1.2 was assumed16,19-22. Data provided by financial
year are shown by year-end to represent completed
use.
Population sources
National population statistics were obtained from
the country-specific statistics bureaus using data
from census years23-35. For non-census years,
population totals were calculated assuming linear
growth (or decline).
Analysis
Total albumin use in kilograms per 10,000 persons
per annum was calculated and plotted to document
trends in albumin use over time and between
jurisdictions. An aggregate figure was calculated
for the years 1995 to 2006 across the surveyed
countries for which annual data were available.
The mass of synthetic colloids per 10,000 persons
per annum were calculated, converted to albumin
equivalent volumes and plotted over time. The use
of albumin and synthetic colloids was standardised
to albumin volume equivalents and plotted over
time to document trends in total colloid use in
the jurisdictions for which data were available.
As data were not available for every year in some
jurisdictions, we report only the available data and
make no assumptions about missing data.
RESULTS
Availability of information on albumin use
Data on annual albumin use were obtained from
13 sources representing 15 countries. Data were
provided by calendar year by 11 countries and by
financial year for the remaining four countries. Data
were incomplete for England and Wales (missing
1995, 1997, 1998 and 2000), Germany (missing 1995
to 1998) and Denmark (missing 1995 to 1996 and
2006). An additional four countries were missing
data on 2006 (data not yet available: New Zealand,
Norway, Sweden and Switzerland) and four
additional countries were missing data for 1995
(Australia, Scotland and Northern Ireland and
Sweden). There was no central, national data source
for albumin use for the USA and we were unable
to identify an alternative reliable data source.

Table 1
Albumin use in kg per 10,000 persons by jurisdiction, aggregate and worldwide, 1995 to 2006
Year Aus Canada Den England Finland France Germany Iceland NZ Norway Scotland and Sweden Switz Aggregate
and Wales Northern of surveyed
Ireland countries
1995 1.37 2.55 1.24 1.40 2.70 3.92 2.54
1996 1.79 2.32 1.93 1.40 1.93 1.07 1.10 2.24 2.45 3.43 3.57 2.10
1997 1.95 2.05 2.20 1.44 1.59 0.93 1.04 2.49 2.66 2.99 2.90 1.95
1998 1.94 1.94 2.02 1.38 1.50 0.58 0.69 2.10 2.77 2.74 2.55 1.83
1999 1.97 1.56 1.26 0.89 1.00 1.54 1.40 0.83 0.54 1.68 1.84 1.70 1.48 1.40
2000 1.98 1.63 1.06 0.87 1.61 1.39 0.68 0.53 1.41 1.37 1.50 1.80 1.51
2001 1.95 1.62 0.92 0.90 0.98 1.70 1.28 0.46 0.50 1.21 1.35 1.73 1.71 1.38
2002 1.76 1.66 0.82 0.86 0.86 1.85 1.21 0.54 0.48 1.11 1.22 1.49 1.88 1.37
2003 1.88 1.68 0.73 0.71 1.92 1.06 0.77 0.48 1.21 1.35 1.42 1.73 1.45
2004 2.04 1.69 0.59 0.87 0.73 1.92 1.04 0.51 0.45 1.25 1.30 1.56 1.67 1.35
2005 2.04 1.75 1.22 0.90 0.79 2.02 1.03 0.72 0.43 1.16 1.12 1.63 1.58 1.39
2006 2.32 1.88 0.94 2.13 0.83 0.96 1.08 1.43

Aus=Australia, Den=Denmark, NZ=New Zealand, Switz=Switzerland

Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
 International albumin use: 1995 to 2006
Albumin use between 1995 and 2006
Data on albumin use (kg/10,000 persons) in the
individual surveyed countries and the aggregate
of the surveyed countries are shown in Table 1
and Figures 1 to 4. The highest national albumin
use in any one year was 3.92 kg per 10,000 persons
in 1995 in Switzerland, the lowest was 0.43 kg
per 10,000 persons in New Zealand in 2005.
The aggregate of albumin use in the surveyed
countries was decreasing prior to the Cochrane
Injuries Group publication in 1998 and decreased
further between 1998 and 1999. Since 1999, changes
in albumin use in the surveyed countries have
generally been less marked. In some countries use
has increased (e.g. Australia); in others use has
been steady (e.g. New Zealand) or declined (e.g.
Germany).
The aggregate use in the surveyed countries
decreased from a peak of 2.54 kg per 10,000
Figure 1: Albumin use per 10,000 persons, study aggregate,
1995 to 2006 (Dotted line indicates timing of Cochrane Albumin
Reviewers publication).
Figure 2: Albumin use per 10,000 persons for Australia, New
Zealand and Canada, 1995 to 2006 (Dotted line indicates timing
of Cochrane Albumin Reviewers publication).
Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
269
persons in 1995 to 1.40 kg per 10,000 persons in
1999. Aggregate albumin use has remained relatively
constant since that time, varying between 1.35 kg
per 10,000 persons in 2004 and 1.51 kg per 10,000
persons in 2000 (Figures 1 to 4).
Use of synthetic colloids between 1995 and 2006
Data on synthetic colloids was available for
Denmark (1997 to 2005), Sweden (1996 to 2005) and
Canada (1995 to 2004). In Denmark HES was the
most commonly used synthetic colloid, followed by
dextran; use of both colloids increased throughout
the observation period. In Sweden, dextran was
initially the most frequently used colloid with a
decline in use throughout the observation period,
whereas HES use increased. In Canada HES use
increased throughout the observation period. Data
on use of individual synthetic colloids in the
surveyed countries are shown in Table 2 and
Figure 5.
Figure 3: Albumin use per 10,000 persons for European
countries (excluding Scandinavia), 1995 to 2006 (Dotted line
indicates timing of Cochrane Albumin Reviewers publication).
Figure 4: Albumin use per 10,000 persons for Scandinavian
countries, 1995 to 2006 (Dotted line indicates timing of Cochrane
Albumin Reviewers publication).
270 D. Jones, S. McEvoy et al

Total use of colloids between 1995 and 2006

Use of synthetic colloids in albumin volume
equivalents increased from 125.5 to 195.1 litres
per 10,000 population in Denmark (1997 to 2005),
from 127.0 to 188.9 litres per 10,000 population in
Sweden (1996 to 2005) and from 11.7 to 71.6 litres
per 10,000 population in Canada (1996 to 2004).
The total use of colloids (albumin plus synthetic
colloids) showed a trend to increase on a per capita
basis in the countries for which data were available
(Figure 6).

Figure 5: Use of synthetic colloids in albumin volume equivalents DISCUSSION

(litres per 10,000 persons) by jurisdiction 1995 to 2005.
Summary of study findings
We conducted an international study to document
annual use of albumin and synthetic colloids in a
number of industrialised countries between 1995
and 2006. We found that reliable information on
colloid use was difficult to obtain and data were not
available for all countries or all years; per capita
albumin use varied up to nine-fold between the
surveyed countries over time. Synthetic colloid use
varied significantly in type and total volume in the
few countries for which data were available. Total
colloid use (albumin plus synthetic colloids) per
capita increased throughout the observation period.

Possible mechanism and comparison with previous

Figure 6: Total colloid use (albumin plus synthetic colloids) in studies
albumin volume equivalents (litres per 10,000 persons) in Sweden, We found up to a nine-fold difference in adjusted
Denmark and Canada 1995 to 2005.
albumin use between the countries surveyed over
time. Although our study cannot explain this
variation, possible explanations include differences
Table 2 in the cost of albumin and differences in the
Use of synthetic colloids in albumin volume equivalents availability of alternative fluids in the countries
(litres per 10,000 persons) by jurisdiction 1995 to 2005 studied. We are unaware of variation in patient
Year Den, Den, Sweden, Sweden, Sweden, Canada, demographics between the surveyed countries that
starches dextran starches dextran gelatins starches
might account for the observed variation in albumin
1995 11.7 use. We have presented the data on a per capita
1996 18.6 108.4 3.0 22.7 basis using the total population of each country as
1997 106.3 19.2 30.6 102.7 2.6 32.0 the denominator. It is possible that differences in the
1998 122.8 21.6 37.5 103.0 3.4 40.3 organisation of health care systems and differences
in hospitalisation rates between countries may also
1999 138.6 25.0 43.5 103.5 2.0 49.2
affect the use of resuscitation fluids.
2000 150.3 30.8 46.5 103.7 2.3 54.7
In 1998, the Cochrane Injuries Group Albumin
2001 148.3 34.8 53.0 104.8 1.0 57.5
Reviewers concluded that administration of
2002 152.4 40.5 44.4 97.0 60.4 albumin-containing fluids resulted in a 6% absolute
2003 142.8 42.2 81.3 91.7 64.2 increase in the risk of death8. A subsequent survey
2004 189.3 42.5 95.1 83.4 71.6 of clinical directors revealed that in many intensive
2005 157.4 37.7 112.9 76.0 care units in the United Kingdom use of intravenous
albumin had been influenced by this review36. In
Den=Denmark. the present study, we found that albumin use in
Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
 International albumin use: 1995 to 2006
the surveyed countries was decreasing prior to the
publication, but we had insufficient data to conduct
time-series analysis to determine whether the
publication had a material effect on the trend in
albumin use37.
In contrast to albumin use, use of synthetic
colloid increased during the study period. When
calculated as volume equivalents, the total volume
of albumin and synthetic colloids has remained
stable or even increased throughout the observation
period. These data do not suggest that clinicians
have changed from using colloid solutions to using
crystalloids, even though colloids are generally
more expensive and meta-analyses report no
outcome advantage with colloids38-40.
We are unaware of any previous study examining
the use of colloids across a decade in multiple
countries. Two surveys have reported clinicians’
preferences in choice of resuscitation fluids2,3.
These studies suggested that most doctors use a
combination of crystalloids and colloids to expand
plasma volume: in 1998 to 1999, albumin was the
most common colloid used in Canada3, whereas
in 2001 to 2002, albumin was used infrequently in
most European countries2.
Study strengths and limitations
Our study is international and may be original
in documenting changes in colloid use over a ten-
year period in individual countries. However, it has
several limitations. First, data were collected
retrospectively, obtained for 15 countries only
and were incomplete for some years. Second, we
found it difficult to obtain comprehensive and
reliable data on colloid use. Data were available
from national blood bank authorities for only five
countries. In the remainder, we sourced data from
commercial entities, drug administration agencies
and pharmacy registries. Data on synthetic colloids
was only available for three countries. We found
that commercial organisations were less willing
or unable to release data because of commercial
sensitivity or because of inadequate data storage
and retrieval systems. Also, data sources have
become more fragmented over time due to the
privatisation of national blood services and
replacement of monopolies by competing suppliers.
Finally, we have reported total albumin use for
each of the surveyed countries and have no
information on the proportion of albumin used
for the treatment of different groups of patients or
for particular indications.
Anaesthesia and Intensive Care, Vol. 38, No. 2, March 2010
271
Implications for clinicians and policy makers
Administration of intravenous fluid is one of the
most common interventions in pre-hospital and
hospital medicine. Accordingly, small differences in
outcomes and relative costs which result from the use
of different fluid preparations may have important
consequences. Although we documented a reduction
in albumin use and increased synthetic colloid use
in those countries for which data were available, we
can only speculate that synthetic colloids are being
used in place of albumin. Our data suggest that many
clinicians continue to use colloid based resuscitation2,
and as synthetic colloids may have adverse effects12,
we do not know whether reduced albumin use has
resulted in a net benefit to patients or in harm.
Unanswered questions and future research
Future research should document current fluid
resuscitation practices internationally and examine
the effects of choice of resuscitation fluid on patient
outcomes. Given the widespread use of resuscitation
fluids in pre-hospital and hospital medicine, further
large-scale international observational studies and
randomised controlled trials are warranted.
Acknowledgements
SAFE TRIPS Investigators
Australian and New Zealand Co-ordinating
Committee
Simon Finfer (Chair), Rinaldo Bellomo, D James
Cooper, Alisa Higgins, Stephanie Hollis, Daryl
Jones, Colin McArthur, Suzanne McEvoy, John
Myburgh, and Robyn Norton; The George Institute
for International Health, University of Sydney,
Sydney; Australian and New Zealand Intensive Care
Research Centre, Department of Epidemiology
and Preventive Medicine, Monash University,
Melbourne.
SAFE TRIPS Investigators by country
Australia
•• Joanne Pink; Australian Red Cross Blood Service.
•• Simon Finfer, Stephanie Hollis, Suzanne McEvoy,
John Myburgh, Robyn Norton; The George
Institute for International Health, University of
Sydney, Sydney.
•• Rinaldo Bellomo, D James Cooper, Alisa Higgins,
Daryl Jones; Australian and New Zealand Intensive
Care Research Centre, Monash University,
Melbourne.
Canada
•• Paul Hebert, Lauralyn McIntyre, Alan Tinmouth;
University of Ottawa, Center for Transfusion and
272 D. Jones, S. McEvoy et al
Critical Care Research, Ottawa Health Research
Institute Ottawa.
England
•• J Duncan Young; Intensive Care Society Trials
Group, Oxford.
•• Simon Stanworth; National Blood Service/Oxford
Radcliffe Hospitals, Oxford.
France
•• Frédérique Schortgen; Groupe Hospitalier
Albert Chenevier – Henri Mondor, Réanimation
Médicale, Créteil.
•• Laurent Brochard; Groupe Hospitalier Albert
Chenevier – Henri Mondor, Réanimation
Médicale, Université Paris, Créteil.
Germany
•• Frank Brunkhorst, Konrad Reinhardt; Department
of Anaesthesiology and Intensive Care Medicine
Friedrich-Schiller-University Jena.
New Zealand
•• Colin McArthur; Department of Critical Care
Medicine, Auckland City Hospital.
•• Peter Flanagan; New Zealand Blood Service.
Scandinavian Critical Care Trials Group
•• Anders Perner; Department of Intensive Care,
Rigshospitalet, Copenhagen, Denmark.
•• Jyrki Tenhunen;  Critical Care Medicine, Tampere
University Hospital, Finland.
•• Sigurbergur Kárason; Department of Anaesthesia
and Intensive Care, Landspitali University
Hospital, Reykjavik, Iceland.
•• Anne Berit Guttormsen; Bergen, Norway.
•• Anders Åneman; Department of Anaesthesiology
and Intensive Care Sahlgrens University Hospital
Goteborg, Sweden.
Scotland and Northern Ireland
•• Brian McClelland; Scottish Blood Transfusion
Service.
Switzerland
•• Tobias M Merz, Jukka Takala; Department of
Intensive Care Medicine, Inselspital, Bern
University Hospital and University of Bern, Bern,
Switzerland.
We would like to thank Patrick Robert and Keith
Berman of The Marketing Research Bureau, Inc.,
Orange, CT 06477, USA for supplying the data on
worldwide albumin use and for assistance in verifying
some country-specific data.
Declaration of interest
CSL partially funded the original SAFE Study
and has refunded travel expenses incurred by SF
in presenting the results at industry sponsored and
academic meetings. Fresenius Kabi has refunded
travel expenses incurred by SF and JM in attending
meetings to discuss research into the clinical effects
of HES in critically ill patients.
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