Long Intravascular Persistence of 20% Albumin in Postoperative Patients

Hasselgren, Emma; Zdolsek, Markus; Zdolsek, Joachim; Björne, Håkan; Krizhanovskii, Camilla; Ntika, Stelia; Hahn, Robert G.

doi:10.1213/ane.0000000000004047

Cited by 39 publications

(75 citation statements)

References 23 publications

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“…In healthy volunteers and in patients on day 1 following major open abdominal surgery, a 30-min intravenous infusion of 3 mL/kg body weight 20% HSA solution expanded the volemic state for almost 2 h, with no important differences in the kinetics of 20% HSA solution between the two study groups 88 . The half-life of the plasma volume expansion was a median 10.3 (interquartile range 5.3-17.6) h in the post-surgery group and 7.6 (3.5-9.0) h in the healthy volunteers 89 . In patients with septic shock, infusion of 20% HSA solution improved endothelial function versus saline by restoring microcirculatory blood flow in the skin 90 .…”

Section: Albumin Kineticsmentioning

confidence: 93%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

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Objective: Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management.

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Section: Albumin Kineticsmentioning

confidence: 93%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

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“…These control patients underwent the same prestudy fasting, albumin infusion and follow-up as the burn patients. Data from this control group has previously been published [10,11].…”

Section: Methodsmentioning

confidence: 99%

Plasma volume expansion and capillary leakage of 20% albumin in burned patients and volunteers

et al. 2020

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Background: Burn injury is associated with a long-standing inflammatory reaction. The use of albumin solutions for plasma volume support is controversial because of concerns of increased capillary leakage, which could aggravate the commonly seen interstitial oedema. Methods: In the present open controlled clinical trial, an intravenous infusion of 20% albumin at 3 mL/kg was given over 30 min to 15 burn patients and 15 healthy volunteers. Blood samples and urine were collected for 5 h. Plasma dilution, plasma albumin and colloid osmotic pressure were compared. Mass balance calculations were used to estimate plasma volume expansion and capillary leakage of fluid and albumin. Results: The patients were studied between 4 and 14 (median, 7) days after the burn injury, which spread over 7-48% (median, 15%) of the total body surface area. The albumin solution expanded the plasma volume by almost 15%, equivalent to twice the infused volume, in both groups. The urinary excretion exceeded the infused volume by a factor of 2.5. Capillary leakage of albumin occurred at a rate of 3.4 ± 1.5 g/h in burn patients and 3.7 ± 1.6 g/h in the volunteers (P = 0.61), which corresponded to 2.4 ± 1.0% and 2.5 ± 1.2% per hour of the intravascular pool (P = 0.85). The median half-life of the plasma volume expansion was 5.9 (25th-75th percentiles 2.7-11.7) h in the burn patients and 6.9 (3.4-8.5) h in the volunteers (P = 0.56). Conclusions: Albumin 20% was an effective volume expander in patients at 1 week post-burn. No relevant differences were found between burn patients and healthy volunteers.

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“…However, the risks probably relate to the specific clinical context. Indeed, while volume loading did not cause glycocalyx shedding in surgical patients and healthy volunteers [52,53], the amount of glycocalyx shedding was proportional to the volume of fluid given in septic shock patients [54].…”

Section: The Basicsmentioning

confidence: 97%

Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Malbrain

Länger

Annane

et al. 2020

Ann. Intensive Care

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178

130

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Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Among crystalloids, balanced solutions limit acid-base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction. Among colloids, albumin, the only available natural colloid, may have beneficial effects. The last decade has seen growing interest in the potential harms related to fluid overloading. In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Active de-escalation protocols may be necessary in a later phase. The R.O.S.E. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims; maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload.

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Long Intravascular Persistence of 20% Albumin in Postoperative Patients

Cited by 39 publications

References 23 publications

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Plasma volume expansion and capillary leakage of 20% albumin in burned patients and volunteers

Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

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