Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials

Jacob, Matthias; Chappell, Daniel; Conzen, Peter; Wilkes, Mahlon M.; Becker, Bernhard F.; Rehm, Markus

doi:10.1186/cc6812

Cited by 78 publications

(68 citation statements)

References 90 publications

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“…[42] They were not designed to assess mortality, and the possibility of ascertainment bias could not be dismissed. Furthermore, information from other sources [14,48] was required because of missing data.…”

Section: Study Quality and Biasmentioning

confidence: 99%

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

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PurposeTo assess the impact of 6% tetrastarch (hydroxyethyl starch (HES) 130/0.4 and 130/0.42) in severe sepsis patients. The primary outcome measure was 90-day mortality. MethodsA structured literature search to identify prospective randomized controlled trials (RCT) in adult patients with severe sepsis receiving 6% tetrastarch (potato or waxy maize origin), as part of fluid resuscitation in comparison to other non-HES fluids after randomisation, in the critical care setting was undertaken. A systematic review and meta-analysis was performed. ResultsSix RCTs were included (n = 3033): three from 2012 (n = 2913) had a low risk of bias. Median tetrastarch exposure was 37.4 ml/kg (range 30 to 43). Ninety-day mortality was associated with tetrastarch exposure (relative risk (RR) 1.13; 95% confidence interval (CI) 1.02 to 1.25; p = 0.02) compared to crystalloid. The number needed to harm (NNH) was 28.8 (95% CI 14.6 to 942.5). Publication bias and statistical heterogeneity (I 2 = 0%) were not present. Tetrastarch exposure was also associated with renal replacement therapy (p = 0.01; NNH 15.7) and allogeneic transfusion support (p = 0.001; NNH 9.9). No difference between groups was observed for 28-day mortality, comparison with colloid as control, and for waxy maize derived tetrastarch, but power was lacking. Overall mortality was associated with tetrastarch exposure (RR 1.13; 95% CI 1.02 to 1.25; p = 0.02). ConclusionsIn our analysis, 6% tetrastarch as part of initial fluid resuscitation for severe sepsis was associated with harm, and as alternatives exist, in our view should be avoided.

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Section: Study Quality and Biasmentioning

confidence: 99%

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

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“…(30) The overall analysis showed no association between hyperoncotic albumin administration and increased mortality; it was shown to be safe and effective in subgroups such as liver disease patients and newborn patients. No significant mortality increase was shown in adult critically ill patients.…”

Section: Main Clinical Trials and Meta-analysismentioning

confidence: 93%

“…Jacob et al (30) More recently, a meta-analysis specifically addressed hyperoncotic albumin formulations (20-25% solution) for small volume resuscitations. (30) The overall analysis showed no association between hyperoncotic albumin administration and increased mortality; it was shown to be safe and effective in subgroups such as liver disease patients and newborn patients.…”

Section: Main Clinical Trials and Meta-analysismentioning

confidence: 99%

“…A repeated analysis performed by the same investigators showed that albumin infusion was an independent contributor to increased 28-day survival and was associated with less progression to liver dysfunction. (36) b) Severe liver disease Exogenous albumin infusion in decompensated cirrhosis is justified in three contexts: prevention of circulatory dysfunction following serial or large-volume paracentesis; (30) reduction of renal dysfunction and mortality in spontaneous bacterial peritonitis patients, for whom albumin is superior to synthetic colloids; (37,38) and, finally, for treatment of hepatorenal syndrome. (39) Transient liver dysfunction after liver transplantation appears to be a reasonable indication for prescribing albumin, but studies confirming this suspicion are scarce.…”

Section: Albumin Effects In Subgroups Of Severely Ill Patientsmentioning

confidence: 99%

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Uso de albumina humana em pacientes graves: controvérsias e recomendações

Falcão

Japiassú²

2011

Rev. bras. ter. intensiva

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“…Albumin reaktif oksijen türlerini thiol grubu sayesinde yok eder [12]. Sepsis sendromu olan hastalarda %20 albumin infüzyonunun plazma thiol konsantrasyonunu arttırdığı bildirilmiştir [13]. İlginç olarak yüksek konsantrasyonda ancak düşük volümde hızla infüze edilen albuminin akciğer dokusundaki antioksidan etkisinin düşük konsantrasyonda ancak geniş volümde yavaş infüzyonunundan daha etkin olduğu saptanmıştır [14].…”

unclassified

Sepsis oluşturulan sıçanlarda farklı konsantrasyonlarda verilen albuminin böbrek antioksidan ve serbest oksijen radikalleri üzerine etkisi

Kara¹,

Umuroğlu²,

Gürsoy³

et al. 2014

MMJ

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ÖZET Amaç: Bu çalışmanın amacı sepsis oluşturulan sıçanlarda antioksidan özellikler gösteren albuminin farklı konsantrasyonlarının böbrek antioksidan düzeyleri ve böbrek fonksiyonları üzerine etkilerini araştırmaktır.Gereç ve Yöntem: Çalışmada 28 adet erişkin Sprague-Dawley sıçan 4 gruba ayrıldı. Birinci gruba (Grup K) herhangi bir ajan uygulanmadı. Diğer gruplarda intraabdominal sepsis oluşturuldu. İkinci gruba (Grup S) 90 dk süreyle 30 ml/kg serum fizyolojik infüzyonu, 3. gruba (Grup A5) 90 dk süreyle 15 ml/kg %5 albumin infüzyonu, 4. gruba (Grup A25) ise 45 dk süreyle 3 ml/kg %25 albumin infüzyonu uygulandı. 18. saatin sonunda tüm sıçanlara anestezi altında bilateral nefrektomi yapıldı. Kan üre nitrojeni, kreatinin ve albumin düzeylerini saptamak için böbrek venlerinden kan örnekleri alındı. Böbrek dokuları elektron mikroskobu altında diseke edilerek serbest oksijen radikalleri ve antioksidan düzeylerinin ölçümü yapıldı.Bulgular: Çalışmamızda serum fizyolojik uygulanan grupla karşılaştırıldığında her 2 konsantrasyonda albumin uygulanan septik sıçanlarda böbrek fonksiyonlarının daha iyi, glutatyon düzeylerinin daha yüksek, malondialdehit ve myeloperoksidaz düzeylerinin daha düşük olduğu saptandı. Ek olarak A25 grubunda kan üre nitrojeni ve böbrek glutatyon düzeyleri A5 grubuna göre belirgin yüksekti.Sonuç: Böbrek dokusunda antioksidan etkilerini saptadığımız %25 albuminin hızlı infüzyonunun sepsis olgularında kullanımının böbrek disfonksiyonu gelişmesini önleme veya geciktirme açısından yüz güldürücü olabileceği düşüncesine varılmıştır.Anahtar kelimeler: Sepsis, Albumin, Oksijen radikalleri, Antioksidan ajanlar ABSTRACTObjectives: The aim of this study is to investigate the effects of different concentrations of albumin, which has antioxidant characteristics on renal antioxidant levels and renal functions in rats with sepsis.Materials and Methods: Twenty-eight adult male Sprague-Dawley rats were divided into 4 groups. No agent was implemented to Group K. Group S received 30 ml/kg of saline infusion for 90 min, Group A5 received 15 ml/kg of 5% albumin infusion for 90 min and Group A25 received 3 ml/kg of 25% albumin infusion for 45 min. At the end of the 18th hour, bilateral nephrectomy was performed. Blood samples were taken to determine blood urea nitrogen, creatinine and albumin levels. Kidney tissue samples were dissected to measure the levels of free oxygen radicals and antioxidants.Results: Better renal function, higher levels of glutathione and malondialdehyde with lower myeloperoxidase levels were obtained in septic rats following treatment with 2 different concentrations of albumin. In Group A25, blood urea nitrogen and renal glutathione levels were significantly higher than in Group A5.Conclusion: We are of the opinion that the rapid infusion of 25% albumin may prevent or delay the occurrence of renal dysfunction in patients with sepsis.Key words: Sepsis, Albumin, Oxygen radicals, Antioxidants GirişGünümüzde sepsis insidansı giderek artmakta ve mortalite oranı %30 ila %50 arasında değişmektedir [1]. K...

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Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials

Abstract: Background Small-volume resuscitation can rapidly correct hypovolemia. Hyperoncotic albumin solutions, long in clinical use, are suitable for small-volume resuscitation; however, their clinical benefits remain uncertain.

Cited by 78 publications

References 90 publications

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Uso de albumina humana em pacientes graves: controvérsias e recomendações

Sepsis oluşturulan sıçanlarda farklı konsantrasyonlarda verilen albuminin böbrek antioksidan ve serbest oksijen radikalleri üzerine etkisi

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