A review of the use of human albumin in burn patients.

This review article examines the use of human albumin (HA) in burn treatment. Generally, there are two scenarios where HA may be administered: acutely as a volume expander during burn shock resuscitation and chronically following resuscitation to correct hypoalbuminemia. Although colloids were the cornerstone of the earliest burn resuscitation formulas, HA was in fact rarely used. More recently however, with the recognition of fluid creep, HA usage during resuscitation has increased. Animal studies demonstrate that during acute fluid resuscitation, administration of colloids, including albumin (ALB), have no ability to arrest the formation of burn wound edema, but they do reduce edema formation in the nonburn soft tissues and help preserve intravascular volume and reduce resuscitation fluid requirements with no apparent increase in extravascular water accumulation in the lung. Human studies suggest that immediate use of ALB during acute resuscitation achieves adequate resuscitation using a lower total overall volume requirement, transiently provides better maintenance of intravascular volume and cardiac output, produces less overall edema gain than crystalloid resuscitation alone but may be associated with increased extravascular lung water accumulation during the first postburn week. However, many questions remain unanswered, and modern, large-scale prospective studies are desperately needed. Maintenance of normal serum ALB levels through continuous supplementation of HA following burn resuscitation is even less well understood. Although this approach makes physiologic sense, the limited amount of available data from human burn studies reveal that chronic ALB supplementation is expensive and may not result in any major clinical benefits. Again, modernized prospective studies are greatly needed in this area.