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

Abstract

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.

Plasma concentrations of syndecan‐1 are dependent on kidney function

“…The limitations of this study include that the excreted syndecan‐1 and heparan sulfate is assumed to stem from the bloodstream, although syndecan‐1 is expressed in the renal tubules as well. The predictions of changes in plasma concentrations resulting from a reduction of CL R assume that the studied glycoproteins follow one‐compartment kinetics, that their release to the circulation is unchanged, and that the plasma volume is 3 L. Moreover the data represent a secondary publication to a study of the clinical efficacy of 20% albumin in burn injury 6,7 . The patients had overcome the acute stage of burn injury and were studied approximately 1 week after the burn incident.…”

“…This present study is a secondary report of a prospective single‐center open‐label trial of the volume effects and capillary leakage of 20% albumin in 15 patients recruited from the Burns Unit of Linköping University Hospital, Sweden, between October 2016 and January 2019 6,7 . The study was approved by the Regional Ethics Committee of Linköping (Dnr 2016/333‐32) and the Swedish Medical Products Agency (Eu‐nr 2016‐000996‐26) and was registered at clinicaltrials.gov (NCT02952378).…”

Ten myths about albumin

“…In contrast, the volume ratio of hydroxyethyl starches compared to crystalloids is approximately 1:1.2. Plasma expansion with HAS 20% amounts to twice the infused volume in burn patients and healthy volunteers [2]. The final volume effect depends on TER which is increased in inflammatory conditions.…”

Plasma disappearance rate of albumin when infused as a 20% solution

“…The present report is a secondary publication to four publications in which 3 mL/kg of 20% albumin (approximately 200 mL) was administered over 30 min at a constant rate by an infusion pump to 70 subjects in the following clinical settings: healthy volunteers ( N = 15) [ 9 ], post-burn patients ( N = 15) [ 10 ], ongoing surgery with minor blood loss ( N = 15) [ 11 ], ongoing surgery with major bleeding ( N = 10) [ 12 ], and postoperative patients ( N = 15) [ 9 ]. Reporting adhered to the STROBE checklist.…”

“…The post-burn study recruited patients with a burn area > 6% of the Total Body Surface Area and age between 18 and 80 years. Exclusion criteria were unconsciousness, severe allergy, kidney failure or heart failure [ 10 ].…”