Human albumin and starch administration in critically ill patients: A prospective randomized clinical trial

Veneman, Thiemo F.; Nijhuis, Jeroen Oude; Woittiez, Arend Jan

doi:10.1007/bf03040900

Cited by 42 publications

(50 citation statements)

References 20 publications

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“…In elderly patients after cardiac surgery, there was no difference in renal dysfunction between the group with albumin supplementation and the group given 6% hydroxyethyl starch (HES) instead of albumin; moreover, endothelial activation was even lower in the HES group [25]. In ICU patients, albumin replacement increased colloid osmotic pressure, but it did not improve fluid balance and pulmonary edema [26], nor did it reduce mortality, duration of ICU stay, mechanical ventilation, or renal replacement therapy [27].…”

Section: Discussionmentioning

confidence: 93%

Is replacement of albumin in major abdominal surgery useful?

Mahkovic-Hergouth

Kompan

2011

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 93%

Is replacement of albumin in major abdominal surgery useful?

Mahkovic-Hergouth

Kompan

2011

Journal of Clinical Anesthesia

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“…Hypoalbuminemia is a common finding in septic patients and is associated with higher morbidity and mortality rates (20). However, the use of albumin to treat hypoalbuminemia in intensive care unit patients remains controversial, with some studies suggesting improved outcomes with correction of hypoalbuminemia (21) and others suggesting no benefit (22,23). The large, multicenter, prospective, randomized controlled trial, the saline versus albumin for fluid resuscitation in the critically ill study (24), suggested that albumin administration may improve outcome in the subgroup of patients with sepsis, although the differences did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Fluid Resuscitation in Severe Sepsis and Septic Shock

Wang²,

Cai

et al. 2007

Shock

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The aim of this study was to investigate whether the type of i.v. fluid administered has an impact on outcome in an animal model of septic shock. The study included 28 anesthetized, invasively monitored, mechanically ventilated female sheep (29.5 +/- 4.0 kg), which received 0.5 g/kg body weight of feces into the abdominal cavity to induce peritonitis. During the surgical operation and 4 h after feces spillage, only Ringer's lactate (RL) was administered in all animals. Thereafter, animals were randomized to receive continuous infusions of RL (n = 7) alone or combined with either 20% albumin (n = 7, volume ratio to RL 1:10) or 6% hydroxyethyl starch (HES) (n = 7, volume ratio to RL 1:1), or gelatin alone (n= 7, no volume limitation). Fluid resuscitation was titrated to maintain pulmonary artery occlusion pressure at baseline levels throughout the experiment. No antibiotics or vasoactive drugs were administered, and animals were monitored until their spontaneous death. Hemodynamic variables were better with HES and albumin than with the other fluids, as reflected by higher stroke volume, cardiac index, and oxygen delivery (all P < 0.05). Hydroxyethyl-starch-treated animals also had lower arterial lactate concentrations (P < 0.01). However, times to develop hypotension and oliguria were similar in all groups. Blood interleukin (IL) 6 concentrations were significantly increased in all groups. The mean survival time was similar in all groups. In this clinically relevant model of prolonged septic shock, albumin and HES solution resulted in higher cardiac output, oxygen delivery, and lower blood lactate levels than gelatin and RL; however, the choice of i.v. fluid did not affect outcome.

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“…Treatment of hypoalbuminemia with hyperoncotic albumin to raise the colloidal oncotic pressure in critically ill patients has been shown not to improve outcome. 6 This is because the underlying pathogenesis of hypoalbuminemia in critical illness is increased capillary permeability due to systemic inflammatory response syndrome leading to interstitial edema and organ failure or dysfunction. Because 60% of albumin is normally in the interstitial space and 6 g/h move from the vascular to interstitial space in a normal person, it is not an ideal volume expander in the sick hypoalbuminemic patient in whom capillary permeability is much increased.…”

mentioning

confidence: 99%