Human albumin solution for resuscitation and volume expansion in critically ill patients

Bunn, Frances; Lefebvre, Carol A.; Po, A. Li Wan; Li, L; Roberts, Ian; Schierhout, Gill

doi:10.1002/14651858.cd001208

Cited by 28 publications

(10 citation statements)

References 53 publications

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“…First, congenitally analbuminemic subjects who have barely detectable C P experience a normal life expectancy 6 and analbuminemic rats have normal reproductive ability. 109 Second, a number of randomized studies have shown that infusion of exogenous albumin has little or no benefit on the medical outcome of hypoalbuminemic patients and may even be harmful, both in adults 110 – 113 and children. 114 , 115 Thus, albumin appears to be a surrogate marker for disease mortality and morbidity.…”

Section: Clinical Implications Of Serum Albumin (C P mentioning

confidence: 99%

Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

Levitt¹,

Levitt²

2016

IJGM

530

403

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Serum albumin concentration (CP) is a remarkably strong prognostic indicator of morbidity and mortality in both sick and seemingly healthy subjects. Surprisingly, the specifics of the pathophysiology underlying the relationship between CP and ill-health are poorly understood. This review provides a summary that is not previously available in the literature, concerning how synthesis, catabolism, and renal and gastrointestinal clearance of albumin interact to bring about albumin homeostasis, with a focus on the clinical factors that influence this homeostasis. In normal humans, the albumin turnover time of about 25 days reflects a liver albumin synthesis rate of about 10.5 g/day balanced by renal (≈6%), gastrointestinal (≈10%), and catabolic (≈84%) clearances. The acute development of hypoalbuminemia with sepsis or trauma results from increased albumin capillary permeability leading to redistribution of albumin from the vascular to interstitial space. The best understood mechanism of chronic hypoalbuminemia is the decreased albumin synthesis observed in liver disease. Decreased albumin production also accounts for hypoalbuminemia observed with a low-protein and normal caloric diet. However, a calorie- and protein-deficient diet does not reduce albumin synthesis and is not associated with hypoalbuminemia, and CP is not a useful marker of malnutrition. In most disease states other than liver disease, albumin synthesis is normal or increased, and hypoalbuminemia reflects an enhanced rate of albumin turnover resulting either from an increased rate of catabolism (a poorly understood phenomenon) or enhanced loss of albumin into the urine (nephrosis) or intestine (protein-losing enteropathy). The latter may occur with subtle intestinal pathology and hence may be more prevalent than commonly appreciated. Clinically, reduced CP appears to be a result rather than a cause of ill-health, and therapy designed to increase CP has limited benefit. The ubiquitous occurrence of hypoalbuminemia in disease states limits the diagnostic utility of the CP measurement.

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Section: Clinical Implications Of Serum Albumin (C P mentioning

confidence: 99%

Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

Levitt¹,

Levitt²

2016

IJGM

530

403

View full text Add to dashboard Cite

show abstract

“…Early and rapid fluid resuscitation with isotonic solutions is the cornerstone of management. For children, however, there is still no clear consensus over the choice of resuscitation fluid, and colloidal solutions (such as human albumin solution) might be better than the cheaper crystalloids (such as normal saline) 34 5 6 7 8 9 10 11 Although physiological explanations have been advanced to support potential benefits of colloids over crystalloids, the current evidence does not support these 3…”

Section: Introductionmentioning

confidence: 97%

Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Akech

Ledermann

Maitland

2010

BMJ

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Objective To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with severe infection.Data sources Medline (1950-2008), PubMed, the Cochrane Library, Embase (1980-2008), and reference lists.Eligibility criteria Published studies comparing fluid resuscitation with crystalloid or colloidal solutions in severe infectious illness in children aged >1 month to ≤12 years. Controlled trials and randomised controlled trials were separately selected by two unblinded investigators who also independently extracted data.Main outcome measures Efficacy in the treatment of shock, mortality, and reported adverse events.Results Nine trials fulfilled criteria, eight of which compared crystalloids with colloids. All trials were conducted in settings with poor resources and predominantly included patients with malaria or dengue haemorrhagic shock. None of the trials had mortality as a primary outcome. Three out of six studies that reported at least one death showed better survival in children resuscitated with colloids compared with crystalloids (Peto fixed odds ratio ranging from 0.18 (95% confidence interval 0.02 to 1.42) to 0.48 (0.06 to 3.99)). Studies contributing data on mortality had some methodological limitations so caution is recommended when interpreting this finding. Studies were heterogeneous so combined estimates were not calculated. The review was limited by inclusion of only published studies.Conclusions The current evidence on choice of fluids for resuscitation in children with infections is weak. While existing trials have provided important evidence in malaria and dengue, resuscitation in children with paediatric sepsis, for which colloids could theoretically be of benefit, has not been studied. The evidence from existing studies is not robust enough to make any definitive recommendations over the choice of resuscitation fluid and a definitive trial is required to address this.

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“…Several surveys have shown that, despite publication of systematic reviews [1, 2, 7], this evidence has not changed clinical practice and most physicians still use colloid products [24, 25]. One survey among pediatric anesthesiologists showed that albumin continues to be the most frequently used volume expander in neonates, whereas alternative colloids are used in older children [25].…”

Section: Discussionmentioning

confidence: 99%

Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines

2009

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IntroductionThere is little experience with the nationwide implementation of an evidence-based pediatric guideline on first-choice fluid for resuscitation in hypovolemia.MethodsWe investigated fluid prescribing behavior at (1) guideline development, (2) after guideline development, and (3) after active implementation and identified potential barriers and facilitators for guideline implementation. In order to minimize costs and to optimize implementation effect, we continuously developed and adjusted implementation strategies according to identified barriers. Implementation success was evaluated using questionnaires, pharmaceutical data, and data from medical records.DiscussionThe most remarkable change occurred after guideline development and dissemination: Normal saline use by neonatologists increased from 22–89% to 100% and by pediatric intensivists from 43–71% to 88–100%, and synthetic colloid use by pediatric intensivists declined from 29–43% to 0–13% with a reduction in albumin use by neonatologists from 11–44% to 0%. After active guideline implementation, most of specialist’s management behavior was according to the guideline.ConclusionStakeholders involved in the developmental process are of great importance in disseminating recommendations before active implementation. Therefore, to successfully implement guidelines and reduce costs of active implementation, any guideline development should consider implementation right from the beginning. Implementation strategies should target identified barriers and will therefore always be guideline specific.

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Human albumin solution for resuscitation and volume expansion in critically ill patients

Cited by 28 publications

References 53 publications

Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines

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