Human Albumin Infusion in Critically Ill and Perioperative Patients: Narrative Rapid Review of Meta-Analyses from the Last Five Years
Christian J. Wiedermann
Abstract:Background: Human albumin, a vital plasma protein with diverse molecular properties, has garnered interest for its therapeutic potential in various diseases, including critical illnesses. However, the efficacy of albumin infusion in critical care and its associated complications remains controversial. To address this, a review of recent meta-analyses was conducted to summarize the evidence pertaining to albumin use in critical illness. Methods: Adhering to the rapid review approach, designed to provide a conci… Show more
“…Albumin is thought to maintain vascular integrity and modulate inflammation in infections. Some studies have pointed to hemodynamic stabilization effects [6], but these have not consistently shown clear clinical benefits. Concerns regarding pulmonary edema and other adverse effects also exist.…”
Section: Comparative Analysismentioning
confidence: 99%
“…Albumin, a crucial plasma protein, plays key roles in maintaining oncotic pressure, transporting substances, regulating pH, and participating in various physiological processes [1][2][3][4]. Its diverse functions render it vital in clinical settings for managing conditions, such as cirrhosis [5] and critical care [6]. Understanding the various roles of albumin is important, especially in the context of cirrhosis and sepsis.…”
Section: Introductionmentioning
confidence: 99%
“…The use of albumin in sepsis presents contrasting effects and is controversial. It is considered for volume resuscitation in septic patients because of its plasma volume expansion capability and potential to improve hemodynamic stability [6,11]. Some studies indicate that albumin might be more advantageous than crystalloids, especially in septic shock [12]; however, these benefits have not been consistently confirmed, leading to debates and weak guideline recommendations [11,[13][14][15].…”
This narrative review critically examines the role of albumin in sepsis management and compares it to its well-established application in liver cirrhosis. Albumin, a key plasma protein, is effective in the management of fluid imbalance, circulatory dysfunction, and inflammation-related complications. However, its role in sepsis is more intricate and characterized by ongoing debate and varied results from clinical studies. In sepsis, the potential benefits of albumin include maintaining vascular integrity and modulating inflammation, yet its consistent clinical efficacy is not as definitive as that in cirrhosis. This review evaluated various clinical trials and evidence, highlighting their limitations and providing practical insights for clinicians. It emphasizes identifying sepsis patient subgroups that are most likely to benefit from albumin therapy, particularly exploring the correction of hypoalbuminemia. This condition, which is significantly corrected in patients with cirrhosis, may have similar therapeutic advantages in sepsis. The potential effectiveness of albumin in the low-volume resuscitation and deresuscitation phases of sepsis management was noted. Given the safety concerns observed in cirrhosis, such as pulmonary edema and hypervolemia associated with albumin therapy, cautious integration of albumin into sepsis treatment is mandatory. Personalized albumin therapy is advocated for tailoring strategies to the specific needs of each patient, based on their clinical presentation and underlying conditions. The need for further research to delineate the role of albumin in sepsis pathophysiology is underscored. The review emphasizes the importance of conducting trials to assess the effectiveness of albumin in correcting hypoalbuminemia in sepsis, its impact on patient outcomes, and the establishment of appropriate dosing and administration methods. This approach to albumin use in sepsis management is posited as a way to potentially improve patient outcomes in this complex clinical scenario while being mindful of the lessons learned from its use in cirrhosis.
“…Albumin is thought to maintain vascular integrity and modulate inflammation in infections. Some studies have pointed to hemodynamic stabilization effects [6], but these have not consistently shown clear clinical benefits. Concerns regarding pulmonary edema and other adverse effects also exist.…”
Section: Comparative Analysismentioning
confidence: 99%
“…Albumin, a crucial plasma protein, plays key roles in maintaining oncotic pressure, transporting substances, regulating pH, and participating in various physiological processes [1][2][3][4]. Its diverse functions render it vital in clinical settings for managing conditions, such as cirrhosis [5] and critical care [6]. Understanding the various roles of albumin is important, especially in the context of cirrhosis and sepsis.…”
Section: Introductionmentioning
confidence: 99%
“…The use of albumin in sepsis presents contrasting effects and is controversial. It is considered for volume resuscitation in septic patients because of its plasma volume expansion capability and potential to improve hemodynamic stability [6,11]. Some studies indicate that albumin might be more advantageous than crystalloids, especially in septic shock [12]; however, these benefits have not been consistently confirmed, leading to debates and weak guideline recommendations [11,[13][14][15].…”
This narrative review critically examines the role of albumin in sepsis management and compares it to its well-established application in liver cirrhosis. Albumin, a key plasma protein, is effective in the management of fluid imbalance, circulatory dysfunction, and inflammation-related complications. However, its role in sepsis is more intricate and characterized by ongoing debate and varied results from clinical studies. In sepsis, the potential benefits of albumin include maintaining vascular integrity and modulating inflammation, yet its consistent clinical efficacy is not as definitive as that in cirrhosis. This review evaluated various clinical trials and evidence, highlighting their limitations and providing practical insights for clinicians. It emphasizes identifying sepsis patient subgroups that are most likely to benefit from albumin therapy, particularly exploring the correction of hypoalbuminemia. This condition, which is significantly corrected in patients with cirrhosis, may have similar therapeutic advantages in sepsis. The potential effectiveness of albumin in the low-volume resuscitation and deresuscitation phases of sepsis management was noted. Given the safety concerns observed in cirrhosis, such as pulmonary edema and hypervolemia associated with albumin therapy, cautious integration of albumin into sepsis treatment is mandatory. Personalized albumin therapy is advocated for tailoring strategies to the specific needs of each patient, based on their clinical presentation and underlying conditions. The need for further research to delineate the role of albumin in sepsis pathophysiology is underscored. The review emphasizes the importance of conducting trials to assess the effectiveness of albumin in correcting hypoalbuminemia in sepsis, its impact on patient outcomes, and the establishment of appropriate dosing and administration methods. This approach to albumin use in sepsis management is posited as a way to potentially improve patient outcomes in this complex clinical scenario while being mindful of the lessons learned from its use in cirrhosis.
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