Efficacy and safety of 20% albumin fluid loading in healthy subjects: a comparison of four resuscitation fluids

Abstract

Recently, buffered salt solutions and 20% albumin (small volume resuscitation) have been advocated as an alternative fluid for intravenous resuscitation. The relative comparative efficacy and potential adverse effects of these solutions have not been evaluated. In a randomized, double blind, cross-over study of six healthy male subjects we compared the pulmonary and hemodynamic effects of intravenous administration of 30 ml/kg of 0.9% saline, Hartmann's solution and 4% albumin, and 6 ml/kg of 20% albumin (albumin dose equivalent). Lung tests (spirometry, ultrasound, impulse oscillometry, diffusion capacity, and plethysmography), two- to three-dimensional Doppler echocardiography, carotid applanation tonometry, blood gases, serum/urine markers of endothelial, and kidney injury were measured before and after each fluid bolus. Data were analyzed with repeated measures ANOVA with effect of fluid type examined as an interaction. Crystalloids caused lung edema [increase in ultrasound B line ( P = 0.006) and airway resistance ( P = 0.009)], but evidence of lung injury [increased angiopoietin-2 ( P = 0.019)] and glycocalyx injury [increased syndecan ( P = 0.026)] was only observed with 0.9% saline. The colloids caused greater left atrial stretch, decrease in lung volumes, and increase in diffusion capacity than the crystalloids, but without pulmonary edema. Stroke work increased proportionally to increase in preload with all four fluids ( R2 = 0.71). There was a greater increase in cardiac output and stroke volume after colloid administration, associated with a reduction in afterload. Hartmann’s solution did not significantly alter ventricular performance. Markers of kidney injury were not affected by any of the fluids administrated. Bolus administration of 20% albumin is both effective and safe in healthy subjects. NEW & NOTEWORTHY Bolus administration of 20% albumin is both effective and safe in healthy subjects when compared with other commonly available crystalloids and colloidal solution.

Plasma Volume Expansion and Fluid Kinetics of 20% Albumin During General Anesthesia and Surgery Lasting for More Than 5 Hours

“…Our data are consistent with prior studies finding that administration of hyperoncotic albumin during surgery increases plasma volume has only a small effect on coagulation 3 and is "effective and safe." 4 The magnitude of the expansion we found was also similar to prior studies. Margarson and Soni 16 infused 20% albumin rapidly into volunteers and found a hemodilution corresponding to 2.1 times the infused volume; the albumin T 1/2 was 8.8 hours.…”

Dynamic changes of angiopoietins and endothelial nitric oxide supply during fluid resuscitation for major gyn-oncological surgery: a prospective observation

“…On the other hand, it has been demonstrated that the sole administration of large amounts of crystalloid fluids is suffice to raise systemic ANG-2 levels. This is independent of inflammatory activation but probably mediated by changes in endothelial shear stress [23][24][25]. In sum, in our patients, this resulted in a significant increase in the ANG-2/1 ratio throughout surgery.…”

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

“…Bolus infusion of 20% HSA solution is effective and safe in healthy subjects, as demonstrated in a randomized, doubleblind, cross-over study which compared the pulmonary and hemodynamic effects of commonly available crystalloid and colloidal solutions, i.e. 30 mL/kg of 0.9% saline, Hartmann's solution, 4% HSA solution, and 6 mL/kg of dose-equivalent 20% HSA solution 91 . Another study in healthy volunteers showed that infusion of 20% HSA solution significantly increased plasma volume by recruiting interstitial fluid 92 .…”