HPE Human albumin handbook | Page 28

Albumin in Intensive Care : Physiological Effects ( SWIPE ) RCT of 20 % or 4 – 5 % human albumin solutions during 48 hours after initiation of fluid resuscitation in 321 ICU patients , the cumulative volume of resuscitation fluid ( primary outcome ) and cumulative fluid balance at 48 hours was lower in the 20 % than in the 4 – 5 % human albumin solution group , with a median volume difference of −600 ml ( 95 % CI , −800 to −400 ; p < 0.001 ); the mean fluid balance difference was −576ml ( 95 % CI , −1033 to −119 ; p = 0.01 ), and 20 % albumin did not negatively impact kidney function . 37
To investigate the use of a 20 % albumin infusion in patients after cardiac surgery , the effects of fluid bolus therapy on fluid balance , haemodynamic parameters , and ICU treatment were compared in the HAS FLAIR study , a sequential period open-label pilot trial . 38 Equivalent cardiovascular optimisation was seen in the 20 % albumin solution and the crystalloids groups , with smaller volumes of resuscitation fluid required in the 20 % albumin infusion group , less positive cumulative balance without negative sequelae , and lower amounts of vasopressor and shorter duration of vasopressor therapy . 38
In an RCT involving 220 patients , administration of 20 % human albumin solution targeted to correct hypoalbuminaemia immediately before surgery increased urine output during surgery and reduced the risk of AKI development after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0g / dl vs . saline . 39
In the skin of two patients with septic shock , microcirculatory blood flow measurements in response to acetylcholine iontophoresis , before and after receiving either saline or human serum albumin 20 % infusion , confirmed the notion that albumin infusion improves endothelial function in septic shock . 40
In combination , correction of hypoalbuminaemia and improvement of endothelial function and renal effects may explain the beneficial effects of albumin infusion on haemodynamics and fluid balance in
41 – 43
critically ill surgical and non-surgical patients . In patients on veno-arterial ECMO ( VA-ECMO ), these mechanisms of action may translate into improved survival , as observed in a retrospective registry at a single ICU . VA-ECMO patients with a positive fluid balance 12 hours after cannulation and who received balanced crystalloids ( n = 171 ) vs . human albumin and balanced crystalloids in a 1:2 mix ( n = 112 ) for fluid resuscitation , albumin-receiving patients had a significantly increased survival . 44
Negative fluid balance Clinical examination , bedside tools , and radiological findings are used to evaluate fluid status , detect fluid overload , and prompt fluid removal in critically ill patients ; the most popular strategy for ongoing management is fluid balance . A positive fluid balance is common among critically ill patients and leads to worse outcomes , particularly in sepsis , ARDS , and AKI . Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload . 45 In this context , use of human albumin solutions at different phases of restrictive fluid resuscitation is increasingly investigated .
RRT is used before additional diuretics are
References 1 Wilson JG , Caffee CS . ARDS Subphenotypes : Understanding a heterogeneous syndrome . Crit Care 2020 ; 24:102 2 Arabi YM , Fowler R , Hayden FG . Critical care management of adults with communityacquired severe respiratory viral infection . Intensive Care Med 2020 ; 46 ( 2 ): 315 – 28 . 3 Perner A et al . Expert statement for the management of hypovolemia in sepsis . Intensive Care Med 2018 Jun ; 44 ( 6 ): 791 – 8 . 4 Perner A , Hjortrup PB , Arabi Y . Focus on fluid therapy in critically ill patients . Intensive Care Med 2019 ; 45 ( 10 ): 1469-71 . 5 Qureshi SH et al . Meta-analysis of colloids versus crystalloids in critically ill , trauma and surgical patients . Br J Surg 2016 ; 103 ( 1 ): 14 – 26 . 6 Hammond NE et al . Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014 : An international crosssectional study . PLoS One 2017 ; 12 ( 5 ): e0176292 . 7 Neavyn MJ et al . Sodium
acetate as a replacement for sodium bicarbonate in medical toxicology : a review . J Med Toxicol 2013 ; 9 ( 3 ): 250 – 4 . 8 Self WH et al . Balanced crystalloids versus saline in noncritically ill adults . N Engl J Med 2018 ; 378 ( 9 ): 819 – 28 . 9 Semler MW et al . Balanced crystalloids versus saline in critically ill adults . N Engl J Med 2018 ; 378 ( 9 ): 829 – 39 . 10 Wiedemann HP et al . Comparison of two fluidmanagement strategies in acute lung injury . N Engl J Med 2006 Jun 15 ; 354 ( 24 ): 2564 – 75 . 11 Wiedermann CJ . Volume replacement therapy options for critically ill patients . Med Klin Intensivmed Notfmed 2011 Sep ; 106 ( 1 ): 53 – 64 . 12 Varadhan KK , Lobo DN . A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery : getting the balance right . Proc Nutr Soc 2010 ; 69 ( 4 ): 488 – 98 . 13 Sakr Y et al . Higher fluid balance increases the risk of death from sepsis : Results from a large international audit . Crit
Care Med 2017 ; 45 ( 3 ): 386 – 94 . 14 Rhodes A et al . Surviving Sepsis Campaign : International guidelines for management of sepsis and septic shock : 2016 . Intensive Care Med 2017 ; 43 ( 3 ): 304 – 77 . 15 Vincent JL . Fluid management in the critically ill . Kidney Int 2019 Jul ; 96 ( 1 ): 52 – 7 . 16 Siddall E , Khatri M , Radhakrishnan J . Capillary leak syndrome : etiologies , pathophysiology , and management . Kidney Int 2017 ; 92 ( 1 ): 37 – 46 . 17 Levy MM , Evans LE , Rhodes A . The Surviving Sepsis Campaign Bundle : 2018 update . Intensive Care Med 2018 ; 44 ( 6 ): 925 – 8 . 18 Marik PE , Byrne L , van Haren F . Fluid resuscitation in sepsis : the great 30 mL per kg hoax . J Thorac Dis 2020 ; 12 ( Suppl 1 ): S37-s47 . 19 Leisman DE et al . Predictors , prevalence , and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock . Crit Care Med 2018 ; 46 ( 2 ): 189 – 98 . 20 Bai X et al . Early versus
delayed administration of norepinephrine in patients with septic shock . Crit Care 2014 ; 18 ( 5 ): 532 . 21 Hamzaoui O , Scheeren TWL , Teboul JL . Norepinephrine in septic shock : when and how much ? Curr Opin Crit Care 2017 ; 23 ( 4 ): 342 – 47 . 22 Silversides JA et al . Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness : a systematic review and meta-analysis . Intensive Care Med 2017 ; 43 ( 2 ): 155 – 70 . 23 Jaffee W , Hodgins S , McGee WT . Tissue edema , fluid balance , and patient outcomes in severe sepsis : An Organ Systems Review . J Intensive Care Med 2018 ; 33 ( 9 ): 502 – 09 . 24 Jonsson AB , Perner A . Changes from 2012 to 2015 in intravenous fluid solutions issued to hospital departments . Acta Anaesthesiol Scand 2017 ; 61 ( 5 ): 532 – 38 . 25 Glassford NJ et al . Changes in intravenous fluid use patterns in Australia and New Zealand :
evidence of research translating into practice . Crit Care Resus 2016 ; 18 ( 2 ): 78 – 88 . 26 Kongsgaard UE , Holtan A , Perner A . Changes in colloid solution sales in Nordic countries . Acta Anaesthesiol Scand 2018 ; 62 ( 4 ): 522 – 30 . 27 Thongprayoon C et al . Risk of acute respiratory failure among hospitalized patients with various admission serum albumin levels : A cohort study . Medicine 2020 ; 99:9 ( e19352 ). 28 Gradel KO et al . Hypoalbuminaemia as a marker of trans-capillary leakage in community-acquired bacteraemia patients . Epidemiol Infect 2018 ; 146 ( 5 ): 648 – 55 . 29 Schwartz N , Sakhnini A , Bisharat N . Predictive modeling of inpatient mortality in departments of internal medicine . Intern Emerg Med 2018 ; 13 ( 2 ): 205 – 11 . 30 Karhu J et al . Lower respiratory ttract virus findings in mechanically ventilated patients with severe community-acquired pneumonia . Clin Infect Dis 2014 ; 59 ( 1 ): 62 – 70 . 31 Uyeki TM et al . Clinical
28 | 2020 | hospitalpharmacyeurope . com