Critically evaluate the use of albumin-containing solutions in critically ill patients.
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.
- 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.
- 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