HPE Human albumin handbook | Page 21

Burn injury Burn injury results in a breakdown of the skin barrier and excessive fluid leakage , including plasma . Fluid resuscitation to restore and maintain tissue perfusion is the foundation of acute burn care . Colloids , because of their molecular properties , aid in blood volume maintenance better than crystalloids , thereby reducing the need for liquid volume . The main colloids used are human albumin and fresh frozen plasma . Human albumin infusion is associated with reduced mortality ( pooled OR 0.34 ; 95 % CI 0.19 – 0.58 , p < 0.001 ). Human albumin infusion was accompanied by reduced respiratory complications , renal dysfunction , need for escharotomy or fasciotomy , tissue necrosis , sepsis , cardiovascular complications , oedema , hypoalbuminaemia , local infection , and gastrointestinal and central nervous system complications . 30
ARDS Pulmonary oedema often occurs in patients with pneumonia , acute respiratory distress syndrome ( ARDS ), heart failure , and post-fluid resuscitation . Human albumin and diuretics can accelerate the clearance of oedema , particularly when pulmonary capillary permeability is restored . 31 Recent studies have shown that human albumin infusion is more effective in promoting oxygenation compared with saline and Ringer ’ s solution in a rabbit model of ARDS . 32 In a randomised controlled trial in hypoproteinaemic patients with acute lung injury / ARDS , oxygenation improved significantly , with greater net fluid balance and better haemodynamic stability , if concentrated human albumin was added to the diuretic therapy . 33 Albumin can also decrease pulmonary collagen I and III levels in lung tissue , which indicates that improvements might be related to alleviation of pulmonary fibrosis . 32
Haemorrhagic shock Patients experience haemorrhagic shock from blood loss , including loss of red blood cells , white blood cells , platelets and plasma . The main treatment for these patients is to restore the effective circulating volume through infusion of blood components , including red blood cells , platelets , plasma , and cryoprecipitate . 34 Human albumin , being the main component of plasma , is more readily available and can be administered swiftly . Thus , it can quickly replenish the effective circulating volume , increase blood pressure , and increase tissue perfusion .
Therefore , it is one of the most important options of fluid resuscitation . However , crystalloids ( balanced fluid , normal saline ) are the first choices for fluid resuscitation for haemorrhagic shock . Because albumin is expensive , its use is not recommended routinely in fluid resuscitation . Human albumin 20 % can be administered as a volume expander when restrictive fluid resuscitation is needed .
Conclusions Human albumin is a natural colloid . Infusion of human albumin can increase plasma colloid osmotic pressure and improve tissue oedema . At the same time , it can also increase the effective circulating volume and improve the perfusion of tissues and organs and improve organ function . Most ICU patients suffer from organ dysfunction , hypoalbuminaemia , hypotension , and tissue oedema .
This article lists common situations for human albumin transfusions in the ICU . Because ICU patients are critically ill and have complex pathophysiology with rapid changes , controversies exist regarding who will benefit most significantly from human albumin transfusion . The published original research works cannot reach a harmonious conclusion due to differences in the baseline level of patients , underlying diseases and severity of the conditions . Therefore , close clinical observation is still required during use , and large , multicentre RCTs should be carried out when conditions permit , in order to obtain a clear answer .
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hypoalbuminemic patients : A prospective , randomized , controlled , pilot study . Crit Care Med 2006 ; 34:2536 – 40 . 22 Chinese Society of Hepatology , Chinese Medical Association . Chinese guidelines on the management of ascites and its related complications in cirrhosis . Hepatol Int 2019 ; 13 ( 1 ): 1 – 21 . 23 Sort P et al . Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis . N Engl J Med 1999 ; 341:403 – 9 . 24 Bernardi M et al . Role of human albumin in the management of complications of liver cirrhosis . J Clin Exp Hepatol 2014 ; 4:302 – 11 . 25 Banares R et al . Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-onchronic liver failure : the RELIEF trial . Hepatology 2013 ; 57:1153 – 62 . 26 Kribben A et al . Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure . Gastroenterology 2012 ; 142:782 – 9 . 
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Hepatol 2010 ; 22:213 – 20 . 28 Zhou YT et al . Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality . BMC Neurol 2018 ; 18 ( 1 ): 127 . 29 Carney N et al . Guidelines for the management of severe traumatic brain injury , Fourth Edition . Neurosurgery 2017 ; 80 ( 1 ): 6 – 15 . 30 Navickis RJ , Greenhalgh DG , Wilkes MM . Albumin in burn shock resuscitation : A meta-analysis of controlled clinical studies . J Burn Care Res 2016 ; 37 ( 3 ): e268 – e278 . 31 Gattinoni L , Cressoni M , Brazzi L . Fluids in ARDS : from onset through recovery . Curr Opin Crit Care 2014 ; 20 ( 4 ): 373 – 7 . 32 Yao L et al . Efficacy of 20 % albumin infusion on coagulation and pulmonary fibrosis in rabbits with ARDS . Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 ; 29 ( 5 ): 407 – 12 . 33 Martin GS et al . A randomized , controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury . Crit Care Med 2005 ; 33 ( 8 ): 1681 – 7 . 34 Gupta B et al . Vasopressors : Do they have any role in hemorrhagic shock ? J Anaesthesiol Clin Pharmacol 2017 ; 33 ( 1 ): 3 – 8 .
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