HPE Human albumin handbook | Page 29

administered to oligo-anuric patients , or if the response to diuretic therapy is inadequate . 46 Furosemide is easily the most common diuretic used in the ICU . 47 When it is administered to mechanically ventilated patients with acute lung injury ( ALI )/ ARDS and serum total protein levels < 6.0g / dl in combination with human serum albumin solution over 72 hours , titrated according to fluid loss and to normalise serum total protein , it significantly increases oxygenation , serum total protein , and net fluid loss vs . placebo . 48 In fact , an earlier study had shown improved lung physiology in patients with ALI / ARDS and hypoproteinaemia treated with human serum albumin solution and furosemide , 49 although the separate effects of each drug were unknown .
Additionally , albumin administration exerted a positive effect on plasma antioxidant thioldependent capacity , as well as on levels of protein oxidative damage , in patients with ALI . 50 Observational data showed that children with severe dengue virus infection who received 20 % human serum albumin solution had better lactate clearance ( a viable surrogate marker of resuscitation adequacy ) and shorter durations of mechanical ventilation , ICU stay , and hospital stay than children treated with 5 % human serum albumin solution . 51
Combining high positive end-expiratory pressure , hyperoncotic human solution for small volume resuscitation , and furosemide or ultrafiltration for fluid removal has been tested in ALI patients . 52 Compared with matched controls , patients who received this combined treatment approach exhibited reductions in cumulative fluid balance , extravascular lung water index , and intraabdominal pressure . Clinical outcomes were also improved , that is , fewer days in the ICU and on mechanical ventilation and lower 28-day mortality , without compromising organ function . 52
In fluid removal with furosemide , diuretic resistance may be dependent upon the severity of hypoalbuminaemia , which itself may be an essential modifier of interactions between human serum albumin solution and furosemide . 53 Further studies are needed to evaluate whether a furosemide stress test could be used to distinguish patients with diuretic resistance . 54 Severe hypoalbuminaemia also hampers furosemide secretion in the tubular lumen , resulting in diuretic resistance , which may be overcome by co-administration of furosemide with hyperoncotic human serum albumin solution .
Conclusions Fluid management is the mainstay of evidence-based supportive care in ARF . Hypovolaemia is a readily reversible causative factor in the development of shock ; however , a positive cumulative fluid balance is common in patients with critical illness and is consistently associated with worse outcomes , particularly in ARDS . Human albumin solutions are safe and facilitate negative fluid balance . Furthermore , hypoalbuminaemia is predictive of antibiotic treatment failure , need of mechanical ventilation , and outcome in community-acquired respiratory infection . As the current best evidence supports the use of human albumin solution in restrictive fluid management of ARF , concomitant increase of serum albumin levels may have additional benefits .
Practice Guidelines by the Infectious Diseases Society of America : 2018 update on diagnosis , treatment , chemoprophylaxis , and institutional outbreak management of seasonal influenza . Clin Infect Dis 2019 ; 68 ( 6 ): 895 – 902 . 32 Ibrahim EH et al . The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting . Chest 2000 2000 / 07 / 01 /; 118 ( 1 ): 146 – 55 . 33 Roberts JA , Pea F , Lipman J . The clinical relevance of plasma protein binding changes . Clin Pharmacokinet 2013 ; 52 ( 1 ): 1 – 8 . 34 Zeitlinger MA et al . Protein binding : do we ever learn ? Antimicrobial agents and chemotherapy 2011 ; 55 ( 7 ): 3067 – 74 . 35 Guilhaumou R et al . Optimization of the treatment with beta-lactam antibiotics in critically ill patientsguidelines from the French Society of Pharmacology and Therapeutics ( Societe Francaise de Pharmacologie et
Therapeutique-SFPT ) and the French Society of Anaesthesia and Intensive Care Medicine ( Societe Francaise d ’ Anesthesie et Reanimation-SFAR ). Crit Care 2019 ; 23 ( 1 ): 104 . 36 Hahn RG et al . Fluid volume kinetics of 20 % albumin . Br J Clin Pharmacol 2019 ; 85 ( 6 ): 1303 – 11 . 37 Martensson J et al . Small volume resuscitation with 20 % albumin in intensive care : physiological effects : The SWIPE randomised clinical trial . Intensive Care Med 2018 ; 44 ( 11 ): 1797 – 806 . 38 Wigmore GJ et al . 20 % human albumin solution fluid bolus administration therapy in patients after cardiac surgery ( the HAS FLAIR Study ). J Cardiothorac Vasc Anesth 2019 ; 33 ( 11 ): 2920 – 27 . 39 Lee EH et al . Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0 g / dl . Anesthesiology 2016 ; 124 ( 5 ): 1001 – 11 .
40 Hariri G et al . Albumin infusion improves endothelial function in septic shock patients : a pilot study . Intensive Care Med 2018 ; 44 ( 5 ): 669 – 71 . 41 Wiedermann CJ , Joannidis M . Albumin replacement in severe sepsis or septic shock . N Engl J Med 2014 ; 371 ( 1 ): 83 . 42 Zampieri FG , Hjortrup PB . Moving albumin into the small volume resuscitation era . Intensive Care Med 2018 ; 44 ( 11 ): 1967 – 9 . 43 Wiedermann CJ , Joannidis M . Nephroprotective potential of human albumin infusion : A narrative review . Gastroenterol Res Pract 2015 ; 2015:912839 . 44 Wengenmayer T , Schroth F , Biever PM , Duerschmied D , Benk C , Trummer G , et al . Albumin fluid resuscitation in patients on venoarterial extracorporeal membrane oxygenation ( VA- ECMO ) therapy is associated with improved survival . Intensive Care Med 2018 ; 44 ( 12 ): 2312 – 14 . 45 Malbrain ML et al . Fluid overload , de-resuscitation , and outcomes in critically ill or injured patients : a systematic review with suggestions for
clinical practice . Anaesthesiol Intensive Ther 2014 ; 46 ( 5 ): 361 – 80 . 46 O ’ Connor ME et al . Defining fluid removal in the intensive care unit : A national and international survey of critical care practice . J Intensive Care Soc 2017 ; 18 ( 4 ): 282 – 88 . 47 McCoy IE , Chertow GM , Chang TI . Patterns of diuretic use in the intensive care unit . PLoS One 2019 ; 14 ( 5 ): e0217911 . 48 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 . 49 Martin G et al . Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury . Crit Care Med 2002 ; 30 ( 10 ): 2175 – 82 . 50 Quinlan GJ et al . Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury . Crit Care Med 2004 ; 32:755 – 9 . 51 Lalitha AV . Impact of resuscitation with 20 % versus 5 % albumin in outcome of severe dengue : A prospective observational study . Pediat Crit
Care Med 2018 ; 19 ( 6 ): 1 . 52 Cordemans C et al . Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure : a pilot study looking at the effects of PAL-treatment . Ann Intensive Care 2012 ; 2 Suppl 1 : S15 . 53 Phakdeekitcharoen B , Boonyawat K . The added-up albumin enhances the diuretic effect of furosemide in patients with hypoalbuminemic chronic kidney disease : a randomized controlled study . BMC Nephrology 2012 Aug 29 ; 13:92 . 54 Lumlertgul N et al . Early versus standard initiation of renal replacement therapy in furosemide stress test nonresponsive acute kidney injury patients ( the FST trial ). Crit Care 2018 Apr 19 ; 22 ( 1 ): 101 .
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