CICM SAQ 2010.1 Q25
Question
Critically evaluate the use of albumin-containing solutions in critically ill patients.
Answer
Answer and interpretation
Albumin solutions are frequently used in critically ill patients for a variety of indications.
- a) Volume replacement: The SAFE study showed that using colloids was equivalent in efficacy and safety to crystalloids.
- b) Hypoalbuminaemia: Clinical conditions that may benefit from albumin replacement for hypoalbuminaemia include those below.
Patients with decompensated liver cirrhosis and spontaneous bacterial peritonitis.
- The administration of albumin results in a reduced incidence of renal failure and reduction in mortality.
Patients with Acute Lung Injury or ARDS.
- The study by Martin CCM 2005 shows that in patients who are hypoproteinaemic with ARDS, adding albumin to frusemide resulted in a significant improvement in oxygenation compared to frusemide alone. There was also a greater net negative fluid balance achieved and better haemodynamic stability in patients receiving albumin.
Head injury:
- The clinical conditions in which you would avoid Albumin replacement is cerebral trauma where the SAFE subgroup analysis reported increased mortality at 28 days and 2 years.
Sepsis:
- In the SAFE subgroup, a trend towards an improved outcome with albumin was noted as compared to saline.
In Australia, albumin is cheap (free). It is also risk free, not associated with serious complications such as coagulation abnormalities and renal failure as seen with other studies
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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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