Large Volume Paracentesis (see Paracentesis, [[Paracentesis]])
Clinical Efficacy
Randomized Trial Comparing Albumin, Dextran 70, and Polygeline in Cirrhosis with Ascites Treated by Paracentesis (Gastroenterology, 1996) [MEDLINE]: post-paracentesis circulatory dysfunction is not spontaneously reversible and is associated with a shorter time to first readmission and shorter survival
Albumin is the best plasma expander to prevent this complication
Trial of Albumin in Cirrhosis with SBP (NEJM, 1999) [MEDLINE]
In Combination with Antibiotics, Albumin Decreased Mortality Rate and the Prevalence of Renal Impairment
Intravenous Fluid Resuscitation in Sepsis (see Sepsis, [[Sepsis]])
Clinical Efficacy
SAFE Trial: Comparing Crystalloid (Normal Saline) vs Colloid (4% Albumin) in Heterogenous Population of ICU Patients (NEJM, 2004) [MEDLINE]
No Difference in 28-Day Mortality or Need for Hemodialysis
Traumatic Brain Injury (TIB) Subgroup: Colloid Use Increased the Mortality Rate (see Traumatic Brain Injury, [[Traumatic Brain Injury]])
Colloid Use in Septic Shock Subgroup Demonstrated a Trend Toward Lower Mortality Rate
ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient (Am J Respir Crit care Med, 2010) [MEDLINE]
Hyper-Oncotic Fluids (Hydroxyethyl Starch, Dextrans, 20-25% Albumin) are Not Recommended, Due to Their Risk of Renal Dysfunction
Hypo-Oncotic Colloids (5% Albumin) are as Effective as Crystalloids
Systematic Review/Meta-Analysis of Albumin in Sepsis (Crit Care Med, 2011) [MEDLINE]
Albumin-Containing Solutions Were Associated with Lower Mortality Than Other Fluid Resuscitation Regimens in Sepsis
Study of Chloride-Restrictive IV Fluid Resuscitation Strategy in Critically Ill Patients (JAMA, 2012) [MEDLINE]: study is based on the observation that hyperchloremia may induce renal vasoconstriction
Chloride-Restrictive IV Fluid Resuscitation Strategy Decreased Incidence of Acute Kidney Injury and Use of Hemodialysis
Chloride-Restrictive IV Fluid Resuscitation Strategy Demonstrated No Difference in Hospital Mortality, Hspital or ICU Length of Stay, or Need for Hemodialysis After Hospital Discharge
28-Day Mortality: no difference between use of crystalloid vs colloid in septic shock
90-Day Mortality: improved with use of colloids (although authors note that these findings need to be confirmed in future trials)
Fluids in Sepsis and Septic Shock Group Study (Ann Intern Med, 2014) [MEDLINE]: network meta-analysis (14 studies, n = 18,916 patients)
Network Meta-Analysis at the 4-Node Level: higher mortality with starches than with crystalloids (high confidence)
Network Meta-Analysis at the 4-Node Level: lower mortality with albumin than with crystalloids (moderate confidence) or starches (moderate confidence)
Network Meta-Analysis at the 6-Node Level: lower mortality with albumin than with saline (moderate confidence) and low-molecular-weight starch (low confidence) and with balanced crystalloids than with saline (low confidence) and low and high-molecular-weight starches (moderate confidence)
Conclusions: resuscitation with balanced crystalloids (lactated ringers, etc) or albumin was associated with decreased mortality, as compared to other fluids
Italian ALBIOS Study of Albumin in Severe Sepsis (NEJM, 2014) [MEDLINE]
Albumin in Addition to Crystalloids Did Not Improve the 28-Day and 90-Day Survival, as Compared to Crystalloid Alone
SAFE Trial: Comparing Crystalloid (Normal Saline) vs Colloid (4% Albumin) in Heterogenous Population of ICU Patients (NEJM, 2004) [MEDLINE]
No Difference in 28-Day Mortality or Need for Hemodialysis
Traumatic Brain Injury (TIB) Subgroup: Colloid Use Increased the Mortality Rate (see Traumatic Brain Injury, [[Traumatic Brain Injury]])
Colloid Use in Septic Shock Subgroup Demonstrated a Trend Toward Lower Mortality Rate
Albumin Physiology/Pharmacology
Hepatic Albumin Synthesis
Albumin Enters the Vascular Space Via Direct Entry from Hepatocytes into the Sinusoids (Traversing the Space of Disse) and By Entry into the Hepatic Lymphatics (Moving into the Thoracic Duct)
Determinants of Serum Albumin Concentration
Rate of Albumin Synthesis
Amount of Albumin Secreted from Hepatocytes
Distribution of Albumin in Body Fluids
Rate of Albumin Degradation
Albumin in the Intravascular Space
Half-Life of Albumin in the Intravascular Space: 16 hrs
Etiology of Loss of Albumin from intravascular Space (ie: from the Plasma)
Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med. Jan 1992;152(1):125-30
The change in serum protein concentration in response to the stress of total joint surgery: a comparison of older versus younger patients. J Am Geriatr Soc. May 1996;44(5):555-8
Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. Jan 1999;134(1):36-42
Low levels of plasma proteins: malnutrition or inflammation?. Clin Chem Lab Med. Feb 1999;37(2):91-6
The role of albumin in critical illness. Br J Anaesth 2000; 85:599-610 [MEDLINE]
Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. Kidney Int. Jul 2001;60(1):333-40
Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int. Jun 2002;61(6):2240-9
Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. Mar 2003;237(3):319-34
Inflammation and reduced albumin synthesis associated with stable decline in serum albumin in hemodialysis patients. Kidney Int. Apr 2004;65(4):1408-15
Serum albumin: relationship to inflammation and nutrition. Semin Dial. Nov-Dec 2004;17(6):432-7
Admission serum albumin is predicitve of outcome in critically ill trauma patients. Am Surg. Dec 2004;70(12):1099-102
Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr. Aug 2004;80(2):299-307
Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant. Jun 2004;19(6):1507-19
Hypoalbuminemia 3 months after hospital discharge: significance for long-term survival. J Am Geriatr Soc. Jul 2005;53(7):1222-6
Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol. Apr 2005;39(4 Suppl 2):S143-6
Hypoalbuminemia in renal failure: pathogenesis and therapeutic considerations. Kidney Blood Press Res. 2005;28(5-6):307-10
Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction. Nephrol Dial Transplant. Sep 2005;20(9):1880-8
Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study. BMJ. Nov 18 2006;333(7577):1044
Quality indicators for the care of undernutrition in vulnerable elders. J Am Geriatr Soc. Oct 2007;55 Suppl 2:S438-42
Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. Jun 2009;23(2):183-91
Hypoalbuminemia in the first 24h of admission is associated with organ dysfunction in burned patients. Burns. Jun 7 2012
Risk factors for reintubation in the post-anaesthetic care unit: a case-control study. Br J Anaesth. Jul 9 2012
Use of Albumin in Acute Respiratory Distress Syndrome (ARDS)
Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care 2014 [MEDLINE]
Use of Albumin in Ascites/Large Volume Paracentesis
Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996; 111:1002-1010 [MEDLINE]
Use of Albumin in Burns
Role of albumin in burnt patients: its efficacy during intensive care. Ann Fr Anesth Reanim 1996; 15:1124-1129 [MEDLINE]
Use of Albumin in Traumatic Brain Injury (TBI)
Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. Aug 30 2007;357(9):874-84
Use of Albumin in Sepsis/Critical Illness
A paradigm for consensus. The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med. Feb 27 1995;155(4):373-9
Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. ALYSIS. Jul 25 1998;317(7153):235-40
Excess mortality after human albumin administration in critically ill patients. Clinical and pathophysiological evidence suggests albumin is harmful. BMJ. Jul 25 1998;317(7153):223-4
Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ. Mar 28 1998;316(7136):961-4
Debate: Albumin administration should be avoided in the critically ill. Crit Care. 2000;4(3):151-5
Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. Mar 24 2001;357(9260):911-6
Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med. Aug 7 2001;135(3):149-64
Albumin administration–what is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol. Oct 2003;20(10):771-93
SAFE Trial: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350:2247–2256 [MEDLINE]
Morbidity in hospitalized patients receiving human albumin: a meta-analysis of randomized, controlled trials. Crit Care Med. Oct 2004;32(10):2029-38
A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. May 27 2004;350(22):2247-56 [MEDLINE]
Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study. Crit Care Med. Oct 2006;34(10):2536-40
A survey of Canadian intensivists’ resuscitation practices in early septic shock. Crit Care. 2007;11(4):R74
Resuscitating patients with early severe sepsis: a Canadian multicentre observational study. Can J Anaesth. Oct 2007;54(10):790-8
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. Jan 2008;34(1):17-60
Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. Jan 2008;36(1):296-327
An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med 2010; 181:1128-1155. DOI: 10.1164/rccm.200711-1664ST [MEDLINE]
Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev. Nov 9 2011;CD001208 [MEDLINE]
The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med. 2011 Feb;39(2):386-91. doi: 10.1097/CCM.0b013e3181ffe217 [MEDLINE]
Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013 Nov 6;310(17):1809-17. doi: 10.1001/jama.2013.280502 [MEDLINE]
Fluid Resuscitation in Sepsis: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2014 Jul 22. doi: 10.7326/M14-0178 [MEDLINE]
ALBIOS Study. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014 Apr 10;370(15):1412-21. doi: 10.1056/NEJMoa1305727. Epub 2014 Mar 18 [MEDLINE]
Use of Albumin Spontaneous Bacterial Peritonitis
Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis. N Engl J Med 1999;341:403-9 [MEDLINE]