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

Wiedermann, Christian J.

doi:10.1080/03007995.2020.1840970

Cited by 37 publications

(28 citation statements)

References 154 publications

(187 reference statements)

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“…We congratulate the author for producing a comprehensive review on the physiology of albumin and its role in perioperative and critically ill patients. However, we disagree with the statement "Albumin has a variety of biological properties and functions, including … buffering capabilities, which may be especially relevant in critically ill patients" [1].…”

Section: Accepted Manuscriptmentioning

confidence: 68%

See 1 more Smart Citation

On acid-base effects of albumin

Krbec

Koudelková

Duška

2021

Current Medical Research and Opinion

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Section: Accepted Manuscriptmentioning

confidence: 68%

“…We read with interest the recent review in this Journal by Christian Wiedermann [1]. We congratulate the author for producing a comprehensive review on the physiology of albumin and its role in perioperative and critically ill patients.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

On acid-base effects of albumin

Krbec

Koudelková

Duška

2021

Current Medical Research and Opinion

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“…Diuretics are frequently prescribed in the critically ill to facilitate liquid removal and have become a pharmacologic adjuvant therapy in ARDS [20] . Studies found that compared with liberal uid strategy or standard care, conservative uid management achieved by restricting uid intake, use of diuretics or hemo ltration, was associated with improved oxygenation, increased ventilation free days, and decreased mortality [21][22][23][24] . What's more, it has been proposed that correction of uid retention may rely on diuretics or renal replacement therapy once the hemodynamic status is stabilized [25] .…”

Section: Discussionmentioning

confidence: 99%

The effect of loop diuretics on 28-day mortality of patients with acute respiratory distress syndrome

Zhang

Chen

Gao

et al. 2021

Preprint

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Background Diuretics have been widely used in critically ill patients while it remains uncertain whether it could reduce mortality of patients with acute respiratory distress syndrome (ARDS). The study aimed to investigate the association between diuretics and 28-day mortality of ARDS patients.Methods This is a secondary analysis of the NHLBI ARDS Network’s FACTT. Patients enrolled in FACTT who did not receive renal replacement therapy within the first 48 hours after enrollment were included. Marginal structural Cox model (MSCM) was used to investigate any association between diuretics and 28-day mortality after correction of both baseline and time-fixed variables. Latent class model (LCA) and subgroup analysis were performed to detect which kind of patents could benefit from diuretics.Results In total, 932 patients were enrolled including 558 in the diuretics group and 374 in the no diuretics group within the first 48 hours. The 28-day mortality was lower in the diuretics group (15.1% vs. 28.1%, p < 0.001). MSCM revealed that diuretics use was related to an improved 28-day mortality (HR 0.78; 95%CI 0.62–0.99; p = 0.04). LCA identified three subtypes, and diuretics were associated with reduced mortality in subtype3, which were characterized by worse renal function and higher CVP. Subgroup analysis indicated survival advantage among patients who are female, sepsis induced ARDS, and those with PaO2/FiO2 < = 150 mmHg, MAP > = 65 mmHg.Conclusion Loop diuretics are associated with reduced 28-day mortality of ARDS patients, after controlling for time-varying confounders. Randomized trials are required to verify the results.

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“…Die "International Fluid Academy" (IFA) empfiehlt HA 20 % bei schweren Verbrennungen, vor allem in der sog. Deresuscitation-Phase [63], also nach initialer Stabilisierung, um dem "fluid creep" entgegen zu wirken [37].…”

Section: Albumin Bei Verbrennungenunclassified

Einsatz von Albumin

Mayerhöfer

Wiedermann

Joannidis

2021

Med Klin Intensivmed Notfmed

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ZusammenfassungDie Saline vs. Albumin Fluid Evaluation (SAFE) Studie hat gezeigt, dass der Einsatz von Albumin als Infusionslösung im Bereich der Volumentherapie fast überall sicher ist. Eine Ausnahme stellt hypoonkotisches Albumin beim Schädel-Hirn-Trauma dar. Während für Patientinnen und Patienten mit Leberzirrhose klare Indikationen existieren, fehlen für andere Einsatzgebiete noch große Studien, die einen klinisch relevanten Vorteil jenseits der hämodynamischen Wirksamkeit zweifelsfrei zeigen konnten und damit einen breiteren Einsatz rechtfertigen würden. Bei der „Large-volume“-Parazentese, der spontanen bakteriellen Peritonitis, aber auch beim hepatorenalen Syndrom ist der Einsatz von Albumin aufgrund eines klinischen Benefits in randomisierten kontrollierten Studien klar empfohlen und etabliert. Beim septischen Schock kann ein Einsatz von Albumin in Erwägung gezogen werden, wobei sich zwei große Studien zu dieser Fragestellung in Deutschland und Italien noch in der Rekrutierungsphase befinden. Für viele Einsatzgebiete in der Volumentherapie gilt, dass Albumin vor allem dann eingesetzt werden kann, wenn andere Maßnahmen zur hämodynamischen Stabilisierung bereits ausgeschöpft sind. Das gilt sowohl für die Volumengabe bei Hypovolämie als auch für das konservative Volumenmanagement einschließlich der sog. Deresuscitation-Phase. Inwieweit die Korrektur einer ausgeprägten Hypoalbuminämie durch Gabe von exogenem Albumin auch das schlechtere Outcome solcher Patientinnen und Patienten verbessert, ist ebenfalls Teil laufender Studien. Auf dem Weg zu einem Mehr an individualisierter Therapie kann in Zukunft die Hypoalbuminämie bei Entscheidungen für oder gegen einen Einsatz von intravenösen Albuminlösungen in der Volumentherapie eine wichtige Rolle einnehmen.

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

Cited by 37 publications

References 154 publications

On acid-base effects of albumin

On acid-base effects of albumin

The effect of loop diuretics on 28-day mortality of patients with acute respiratory distress syndrome

Einsatz von Albumin

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