Human albumin : cardiac surgery
20 index increased significantly compared to preoperative level , however , HES solutions increased cardiac index slightly more than did albumin .
Navickis et al have published metaanalysis compared use of HES solutions to albumin : haemodynamics was similar in both groups , but the use of albumin decreased blood loss , amount of blood products transfusions and need for reoperation postoperatively . 16 However , this meta-analysis has insufficient data about the use of tetrastarch HES130 / 0.4 . Some investigators reported a very interesting fact : when the use of albumin solution was compared to other colloids with non-biological origin or to crystalloids , the platelet count in the albumin group were significantly higher postoperatively then in the other fluids group . 13 This ' platelet preservation ' effect of albumin has been discussed in several forums , however , the mechanisms of this effect are still unclear . Some studies reported slight hypocoagulation after albumin use , but these changes are caused more by haemodilution effect . Based on these findings , the use of albumin solution after cardiac surgery is safe also in those patients wh0 already have increased blood loss . The metaanalysis of controlled studies published in 2004 included 1346 patients and compared the use of albumin to crystalloid solution for the CPB priming . Albumin prime preserved platelet counts better than crystalloid , and favourably influenced colloid oncotic pressure and positive fluid balance after cardiac surgery . 17
Because of its biological origin , albumin has multiple functions . It is possible that albumin coats from inside the tubes and reservoir of CPB circuit and therefore reduces contact activation of leucocytes and platelets , which occurs during CPB . Jacob et al reported that albumin also has a protective effect on the endothelial glycocalix , which is damaged during CPB . 8
At this time , debates about volume replacement therapy are at the top of scientific discussion . Some countries stopped the use of synthetic colloids because of the results of a few studies in the critically ill patients , which demonstrated that HES solutions probably impair renal function and even outcome . 18 Despite the fact that the conclusions to these studies are questionable and their results are impossible to extrapolate to the surgical patients , the fact is that more and more hospitals have abandoned the use of synthetic colloids until such time as they receive new data about their safety in patients scheduled for surgical procedures .
More and more hospitals use only crystalloids , even for volume replacement , which leads to the increased amount of fluids given . Because the degree of systemic inflammatory response reaction and damage of endothelial glycocalix after cardiac surgery is high , and patients often have a lot of comorbidities , the use of pure crystalloid volume replacement is possibly not justified . Use of albumin solution should be considered for volume replacement
during or after cardiac surgery , at least in those patients at risk of bleeding or renal dysfunction . Albumin solution provides good haemodynamic effect which lasts several hours without any clinically significant side-effects . In those special cases when patients are already fluid overloaded ( for example , emergency surgery or transplantation patients ), the use of small amounts of hyperoncotic albumin solution should be considered . In the field of cardiac surgery , only data from small prospective randomised studies compared albumin to crystalloids or other colloids . The big multicentre studies investigating albumin solution after cardiac surgery are welcome and , hopefully , after results of these studies are known , we will have the possibility of further improving our volume replacement therapy . l
References
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