Kinetics of 5% and 20% albumin: A controlled crossover trial in volunteers

Zdolsek, Markus; Hahn, Robert G.

doi:10.1111/aas.14074

Cited by 8 publications

(14 citation statements)

References 35 publications

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“…This can be further explained by the revised Starling equation and glycocalyx model that show up to four times the capillary leak in septic shock patients ( 33 , 34 ). The larger effect on hemoglobin change from the 5% albumin solutions has been previously studied ( 32 , 35 ) and can be explained by multiple factors. First, the isooncotic solutions are administered with more volume (five-fold more for the 500 mL solution).…”

Section: Discussionmentioning

confidence: 86%

“…Most studies on the volume-expanding effect of albumin have only considered the effect over at most 5–6 hours ( 26 , 28 , 29 , 31 , 32 ). The effect on the hemoglobin concentrations over time agrees with other studies ( 28 , 32 ), but reveals that the effect lasts for longer than initially expected, even in patients with severe diseases such as septic shock. Though the effect is reduced in said subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…First, the isooncotic solutions are administered with more volume (five-fold more for the 500 mL solution). Second, the hyperoncotic formula probably increased the hydrostatic pressure, causing a reduction in the volume of fluid that moves between the capillaries and the interstitial space ( 32 ). Thus, rendering it a less suitable option for volume resuscitation.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

Abdelhamid,

Achermann,

Hollinger

et al. 2024

Critical Care Medicine

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OBJECTIVES: The aim of this study was to analyze the development of albumin administration in patients admitted to the adult ICU. In addition, we assessed the impact of albumin administration on serum hemoglobin concentration. DESIGN: We conducted a retrospective single-center study including all patients who were admitted to the ICU from January 2013 to December 2021 and stayed at least 24 hours. SETTING: The study was conducted in an academic hospital (University Hospital Basel, Switzerland). PATIENTS: A total of 20,927 admissions were included, of which 3748 received albumin at least once during their ICU stay. To analyze volume expansion, 2006 admissions met the inclusion criteria, namely at least two hemoglobin measurements within 12 hours, one albumin delivery, and experienced no bleeding, dialysis, or transfusions during this period. INTERVENTIONS: None. MEASUREMENTS: We examined the hemoglobin levels before and after albumin administration and compared them with a matched control group to assess the amount and duration of volume expansion. MAIN RESULTS: From 2013 to 2021 the proportion of critically ill patients treated with albumin rose from 5.0% to 32.5%. An overproportioned increase in albumin use could be seen in surgical patients (4.7–47.2%) and in those receiving RBC transfusion (13.7–72.6%). In those patients receiving albumin, a significant drop in hemoglobin of around 5 g/L on average could be observed following treatment with albumin. CONCLUSION: Hemodilution was observable for at least 12 hours after albumin administration and may have caused a decrease in hemoglobin concentration of greater than 8 g/L when isooncotic albumin solution (5%, 25 g in 500 mL) was administered. This makes albumin, especially in its isooncotic form, an ideal colloid to achieve long-lasting volume expansion. However, RBC transfusions may increase under albumin therapy, as transfusion thresholds may be undershot after albumin administration.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

Abdelhamid,

Achermann,

Hollinger

et al. 2024

Critical Care Medicine

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“…1 . 5% albumin (Albumin CSL 5%, CSL Behring, Bern, Switzerland) was given at a volume of 12 mL/kg (ideal body weight), was started, and continued over 30 min at a constant rate during removal of the bladder [ 21 ]. 20% albumin (Albumin CSL 20%, CSL Behring, Bern, Switzerland) 3 mL/kg (ideal body weight) was started and continued over 30 min at a constant rate during removal of the bladder [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial

Jardot,

Hahn,

Engel

et al. 2024

Crit Care

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Background Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate, when infused during major surgery. Methods In this single-center randomized controlled trial, fluid replacement therapy to combat hypovolemia during the hemorrhagic phase of cystectomy was randomly allocated in 42 patients to receive either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 min at the beginning of the hemorrhagic phase, both completed by a Ringer-lactate replacing blood loss in a 1:1 ratio, or Ringer-lactate alone to replace blood loss in a 3:1 ratio. Measurements of blood hemoglobin over 5 h were used to estimate the effectiveness of each fluid to expand the blood volume using the following regression equation: blood loss plus blood volume expansion = factor + volume of infused albumin + volume of infused Ringer-lactate. Results The median hemorrhage was 848 mL [IQR: 615–1145]. The regression equation showed that the Ringer-lactate solution expanded the plasma volume by 0.18 times the infused volume while the corresponding power of 5% and 20% albumin was 0.74 and 2.09, respectively. The Ringer-lactate only fluid program resulted in slight hypovolemia (mean, − 313 mL). The 5% and 20% albumin programs were more effective in filling the vascular system; this was evidenced by blood volume changes of only + 63 mL and − 44 mL, respectively, by long-lasting plasma volume expansion with median half time of 5.5 h and 4.8 h, respectively, and by an increase in the central venous pressure. Conclusion The power to expand the plasma volume was 4 and almost 12 times greater for 5% albumin and 20% albumin than for Ringer-lactate, and the effect was sustained over 5 h. The clinical efficacy of albumin during major hemorrhage was quite similar to previous studies with no hemorrhage. Trial registration: ClinicalTrials.gov NCT05391607, date of registration May 26, 2022.

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“…This conclusion also challenges the Revised Starling Principle, which describes a molecular filter that produces a protein-free filtrate in the sub-glycocalyx region that strongly restricts fluid movements from tissue to plasma [ 42 ]. Physiological findings questioning the Revised Starling Principle include the well-documented process of transcapillary refill [ 43 ] and that the oncotic properties of 20% albumin do recruit extravascular fluid [ 44 – 46 ].…”

Section: In Vivo Glycocalyx and Permeability In Animalsmentioning

confidence: 99%

The glycocalyx as a permeability barrier: basic science and clinical evidence

Dull

Hahn

2022

Crit Care

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Preclinical studies in animals and human clinical trials question whether the endothelial glycocalyx layer is a clinically important permeability barrier. Glycocalyx breakdown products in plasma mostly originate from 99.6–99.8% of the endothelial surface not involved in transendothelial passage of water and proteins. Fragment concentrations correlate poorly with in vivo imaging of glycocalyx thickness, and calculations of expected glycocalyx resistance are incompatible with measured hydraulic conductivity values. Increases in plasma breakdown products in rats did not correlate with vascular permeability. Clinically, three studies in humans show inverse correlations between glycocalyx degradation products and the capillary leakage of albumin and fluid.

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Kinetics of 5% and 20% albumin: A controlled crossover trial in volunteers

Cited by 8 publications

References 35 publications

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial

The glycocalyx as a permeability barrier: basic science and clinical evidence

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