Current guidelines strongly recommend the inclusion of albumin solutions in the circulatory support in certain critically ill patients and in complications of cirrhosis of the liver
Human albumin may therefore be preferentially used in cases where a sustained action on the blood volume is required or when there is a contraindication for non-protein colloids .
Indications and clinical benefits of human albumin Evidence-based use of albumin solutions in fluid therapy has been shown in acute conditions such as expansion of plasma volume for maintenance of effective circulatory blood volume ( volume resuscitation ) as weil as in some chronic conditions with low serum albumin . Hypoalbuminemia is a known prognostic factor for adverse outcome and administration of albumin solution has been shown to reduce morbidity . 8 , 9 Its use is also considered appropriate in the exchange of large volumes of plasma . 10
Current consensus and recommendations Regarding volume resuscitation , current consensus and guideline recommendations are controversial . Studies confirm that the volume effect of albumin is superior to that of crystalloids . 11 The exclusive use of crystailoids is nevertheless proposed by some experts in the field ; crystalloids as a first choice followed by colloids as a second choice is recommended by others . The issue of which type of colloid should be used ( artificial or natural ) is controversial too , including when ( early versus late ) and where ( emergency , ICU , surgery ). However , clinical trials have confirmed longstanding safety concerns regarding the widespread use of artificial colloids . In contrast , human albumin solutions have been confirmed to be safe and effective in various clinical indications ; in particular some complications in cirrhosis of the liver and in intensive care medicine , where the subgroup of patients with severe sepsis or septic shock has been shown in the SAFE study , and subsequent clinical trials and meta-analyses , to derive significant survival benefit .
Clinical indications Before having been abandoned because of higher costs and conflicting results of meta-analyses in
TABLE 2
Clinical uses of human albumin solution
• Circulatory support in critically ill patients
• Cirrhosis and some of its complications ( ascites and large volume paracentesis , sponteneous bacterial peritonitis , hepato-renal syndrome , ascites )
• Severe sepsis or septic shock ( volume resuscitation end disturbance of microcirculation )
• Burns ( after 24 hours )
• Cardiac surgery
• Post-surgical ( post-haemorrhagic hypovolaemia )
• Acute respirotory distress syndrome
• Malabsorption syndromes
• Plasmapheresis
• Ovarian hyperstimulation syndrome
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