Human albumin : benefits |
||||
10 |
resuscitation by intravenous administration of crystalloids and albumin , combined with vasoactive amines and early surgical and / or antibiotic therapy of infection , are crucial in the treatment of severe sepsis and septic shock . Artificial colloids are harmful in these situations . Updated guidelines 14 suggest the use of albumin in the presence of at least one the following conditions :
●● evidence of increased capillary permeability ( pulmonary oedema and / or oedema peripheral );
●● failure to respond to the initial administration of at least 2 litres of crystalloid . In surgical patients , according to guidelines used by some hospitals , the use of albumin may be indicated in patients undergoing major surgery ( resection liver > 40 %, large bowel resection ) if , after normalisation blood volume , serum albumin is < 2 g / dL . 9 , 15 The use of albumin in cardiac surgery is recommended in various guidelines for both filling of the heart-lung machine and perioperatively to reduce oedema . 16 The synthetic colloids have been shown in several clinical studies and meta-analysis to increase postoperative bleeding and number of reoperations . 17
In burns , albumin is not the therapy of first choice in the first 24 hours , when crystalloids are to be used . In accordance with guidelines , albumin solutions are associated with crystalloids when burns cover more than 30 % body surface area and with albumin levels less than 20g / l or when crystalloid therapy was not effective in the correction of hypovolemia . 18
For plasmapheresis , human albumin is primarily recommended as compared to crystalloids or synthetic colloids , when the plasma exchange procedure concerns large plasma volumes (> 20 ml / kg in one sitting , or > 20ml / kg per week in case of repeated procedures ). Crystalloid and albumin / crystalloid combinations are cost-effectiveness alternatives for plasmapheresis at smaller volumes . 10
In ovarian hyperstimulation syndrome , use of albumin solutions has been investigated in several clinical studies that showed effectiveness of colloid administration in the prevention of this syndrome . 19
Conclusions Appropriate use of albumin solutions in hospitals is subject to guideline recommendations and control . Considering the latest publications on the tolerability of the synthetic colloids and
|
their risk of adverse reactions , recommendations for colloids ’ use will increasingly differentiate between natural and artificial , in particular when volume resuscitation in intensive care and surgery is concerned . 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 . l |
References
1 . Quinlan GJ , Martin GS , Evans TW . Albumin : biochemical properties and therapeutic potential . Hepatol 2005 ; 41:1211 – 9 .
2 . Mitzner S et al . Albumin-bound substances – a new target in liver failure therapy . Z Gastroenterol 2001 ; 39 Suppl 2:6 – 7 .
3 . Bertucci C , Domenici E . Reversible and covalent binding of drugs to human serum albumin : methodological approaches and physiological relevance . Curr Med Chem 2002 ; 9:1463 – 81 .
4 . Inoue M et al . Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients . Kidney Int 1987 ; 32:198 – 203 .
5 . Keaney JF Jr et al . NO forms an adduct with serum albumin that has endothelium-derived relaxing factor-like properties . J Clin Invest 1993 ; 91:1582 – 9 .
6 . Demling RH . Effect of plasma and interstitial protein content on tissue edema formation . Curr Stud Hematol Blood Transfus 1986 ; 53:36 – 52 .
7 . Zhang WJ , Frei B . Albumin selectively inhibits TNF alpha-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells . Cardiovasc Res 2002 ; 55:820 – 9 .
8 . Wiedermann CJ , Wiedermann W , Joannidis M . Hypoalbuminemia and acute kidney injury : a meta-analysis of observational clinical studies . Intens Care Med 2010 ; 36:1657 – 65 .
9 . Vincent JL , Navickis RJ , Wilkes MM . Morbidity in hospitalized patients receiving human albumin : a meta-analysis of randomized , controlled trials . Crit Care Med 2004 ; 32:2029 – 38 .
|
10 . Szczepiorkowski ZM et al . Apheresis Applications Committee of the American Society for Apheresis . Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis . J Clin Apher 2010 ; 25:83 – 177 .
11 . Jacob M et al . The intravascular volume effect of Ringer ' s lactate is below 20 %: a prospective study in humans . Crit Care 2012 ; 16 : R86 .
12 . Bernardi M , Caraceni P , Navickis RJ , Wilkes MM . Albumin infusion in patients undergoing large-volume paracentesis : a meta-analysis of randomized trials . J Hepatol 2012 ; 55:1172 – 81 .
13 . European Association for the Study of the Liver . EASL clinical practice guidelines on the management of ascites , spontaneous bacterial peritonitis , and hepatorenal syndrome in cirrhosis . J Hepatol 2010 ; 53:397 – 417 .
14 . Dellinger RP et al . Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup . Surviving Sepsis Campaign : international guidelines for management of severe sepsis and septic shock , 2012 . Intens Care Med 2013 ; 39:165 – 228 .
15 . Haynes GR , Navickis RJ , Wilkes MM . Albumin administration : what is the evidence of clinical benefit ? A systematic review of randomized controlled trials . Eur J Anaesthesiol 2003 ; 20:771 – 3 .
16 . Russell JA , Navickis RJ , Wilkes MM . Albumin versus crystalloid for pump priming in cardiac surgery : meta-analysis of controlled trials . J Cardiothorac Vasc Anesth 2004 Aug ; 18 ( 4 ): 429 – 37 .
17 . Navickis RJ , Haynes GR , Wilkes MM . Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass : a meta-analysis of randomized trials . J Thorac Cardiovasc Surg 2012 ; 144:223 – 30 .
18 . Cochran A , Morris SE , Edelman LS , Saffle JR . Burn patient characteristics and outcomes following resuscitation with albumin . Burns 2007 ; 33:25 – 30 .
19 . Youssef MA , Al-Inany HG , Evers JL , Aboulghar M . Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome . Cochrane Database Syst Rev 2011 ; 16 : CD001302 .
|
www . hospitalpharmacyeurope . com |