Pietro Caironi1, Thomas Langer, Luciano Gattinoni. 1. aDipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano bDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
PURPOSE OF REVIEW: The use of albumin-containing solutions in critically ill patients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients. RECENT FINDINGS: The revision of Starling's theory on microvascular fluid dynamics has highlighted the role of albumin in preserving intravascular compartment volume. In cirrhosis, albumin may be important in maintaining immune system reactivity and cardiac contractility. Preliminary analyses indicate albumin as beneficial in patients with burn, while being associated with increased risk of acute kidney injury after cardiac surgery. The first RCT (ALBIOS trial) testing the efficacy of albumin replacement in severe sepsis did not show a survival benefit associated with albumin, although observing at post-hoc analysis a benefit in septic shock. All the eight meta-analyses performed on albumin in sepsis reveal an absence of harm, and likely a benefit lower than expected, whereas suggesting an advantage, to be verified, in septic shock. SUMMARY: Further studies are needed to clarify physiology and clinical impact of albumin in critically ill patients, considering specific phenotypes and secondary outcomes other than survival, yet clinically relevant.
PURPOSE OF REVIEW: The use of albumin-containing solutions in critically illpatients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients. RECENT FINDINGS: The revision of Starling's theory on microvascular fluid dynamics has highlighted the role of albumin in preserving intravascular compartment volume. In cirrhosis, albumin may be important in maintaining immune system reactivity and cardiac contractility. Preliminary analyses indicate albumin as beneficial in patients with burn, while being associated with increased risk of acute kidney injury after cardiac surgery. The first RCT (ALBIOS trial) testing the efficacy of albumin replacement in severe sepsis did not show a survival benefit associated with albumin, although observing at post-hoc analysis a benefit in septic shock. All the eight meta-analyses performed on albumin in sepsis reveal an absence of harm, and likely a benefit lower than expected, whereas suggesting an advantage, to be verified, in septic shock. SUMMARY: Further studies are needed to clarify physiology and clinical impact of albumin in critically illpatients, considering specific phenotypes and secondary outcomes other than survival, yet clinically relevant.
Authors: Manu L N G Malbrain; Thomas Langer; Djillali Annane; Luciano Gattinoni; Paul Elbers; Robert G Hahn; Inneke De Laet; Andrea Minini; Adrian Wong; Can Ince; David Muckart; Monty Mythen; Pietro Caironi; Niels Van Regenmortel Journal: Ann Intensive Care Date: 2020-05-24 Impact factor: 6.925
Authors: Thomas Langer; Veronica D'Oria; Giulia C I Spolidoro; Giovanna Chidini; Stefano Scalia Catenacci; Tiziana Marchesi; Marta Guerrini; Andrea Cislaghi; Carlo Agostoni; Antonio Pesenti; Edoardo Calderini Journal: BMC Pediatr Date: 2020-09-05 Impact factor: 2.125