Albumin

22/10/10
SP Notes
-

colloid solution
4, 10, 20%
use in the critically unwell = controversial
uses:

-> volume replacement (SAFE showed that it is equivalent to N/S)

-> hypoalbuminaemia (cirrhosis, SBP -> reduces mortality and renal failure)
PREPARATION
- pooled solution
- by-product of whole blood fractionation
ARGUMENTS AGAINST
- possible infection transmission
- possible allergic reactions
- very expensive (most expensive colloid) -> unable to be used in developing
countries
ARGUMENTS FOR
- rates of infection transmission extremely low
- free in Australia

EVIDENCE
Cochrane meta-analysis (1998)
- 24 trials
- 1419 patients
- albumin vs N/S in hypovolaemia, burns and hypovolaemia
-> increased mortality (6% increase in absolute risk of death)
Meta-analysis (2001)
- 55 trials
- 3504 patients
-> no significant increase in mortality
Martin (CCM, 2002)
- RCT demonstrating improved mortality with albumin through improved
oxygenation to hypo-proteinaemic patients with ALI.
Sort (NEJM, 2002)

Jeremy Fernando (2011)

- RCT showing improved mortality in patients with spontaneous bacterial

peritonitis.
SAFE trial (NEJM, 2004)
- MRCT
- n = 6997
- primary end points: 28 day mortality
- powered to detect a 3% absolute reduction in mortality
-> confirmed that 4% albumin was safe when compared to normal saline in the
critically unwell requiring fluid resuscitation.
-> post hoc analysis showed that patients with TBI and major trauma had worse
outcomes with albumin and patients with septic shock tended to better with
albumin.
-> ARDS patients do better with albumin.
Martin (CCM, 2005)
- patients who are hypoproteinaemic with ARDS when given albumin + frusemide
vs frusemide alone
-> improved oxygenation
-> improved haemodynamic stability
Myburgh, J. A. and Finfer, S. (2009) Albumin is a Blood Product too is it safe for
all patients? Critical Care and Resuscitation, 11:67-70
- SAFE as compared to N/S (except in TBI)
- possible trend to decreased mortality in severe sepsis (needs further
investigation)
- hypoalbuminaemia is associated with increased mortality -> volume
resuscitation with albumin doesnt reduce
-> mortality
-> duration of ICU stay
-> duration of mechanical ventilation
-> duration of RRT
- no substantive evidence to justify use of hyperoncotic albumin although we it
does increase intravascular volume from its oncotic effect
- expensive
MY APPROACH
-

use in spontaneous bacterial peritonitis

can use in resuscitation of ICU patients (except those with TBI)
use in ARDS in patients with low albumin with frusemide
may be associated with benefit in severe sepsis (awaiting further studies)
I dont use to correct hypoalbuminaemia
dont use hyperoncotic albumin
recognize expense and increase transfusion related risks

Jeremy Fernando (2011)