Laura Liu1,2, Stuart A McCluskey2,3,4, Michael Law5,6, Lusine Abrahamyan7,8, Miki Peer2, Gordon Tait2,4, Vivek Rao9, Duminda N Wijeysundera4,8,10, Damon C Scales11,12,13, Jeannie Callum11,14, Keyvan Karkouti2,3,4,7,8, Justyna Bartoszko15,16,17,18. 1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 2. Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada. 3. Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 4. Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 5. Department of Anesthesia, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada. 6. Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, Vancouver, BC, Canada. 7. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 8. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 9. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 10. Department of Anesthesia, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 11. Sunnybrook Research Institute, Toronto, ON, Canada. 12. Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 13. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 14. Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queens University, Kingston, ON, Canada. 15. Department of Anesthesia and Pain Management, Toronto General Hospital - University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada. justyna.bartoszko@uhn.ca. 16. Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. justyna.bartoszko@uhn.ca. 17. Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. justyna.bartoszko@uhn.ca. 18. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. justyna.bartoszko@uhn.ca.
Abstract
PURPOSE: To evaluate the perceptions and practices of Canadian cardiovascular anesthesiologists and intensivists towards intravenous albumin as a resuscitation fluid in patients undergoing cardiac surgery. METHODS: We conducted a cross-sectional survey of cardiac anesthesiologists and intensivists involved in the care of cardiac surgical patients. The 22-item survey included seven open-ended questions and assessed practice patterns and attitudes towards albumin. Descriptive statistics were analyzed using counts and proportions. Qualitative data were analyzed to identify themes describing albumin use patterns in Canada. RESULTS: A total of 133 respondents from seven provinces participated, with 83 (62%) using albumin perioperatively. The majority of respondents (77%) felt a low fluid balance in cardiac surgical patients was important, and that supplementing crystalloids with albumin was helpful for this objective (67%). There was poor agreement among survey respondents regarding the role of albumin for faster vasopressor weaning or intensive care discharge, and ≥ 90% did not feel albumin reduced mortality, renal injury, or coagulopathy. Nevertheless, cardiac surgical patients were identified as a distinct population where albumin may help to minimize fluid balance. There was an acknowledged paucity of formal evidence supporting possible benefits. Fewer than 10% of respondents could identify institutional or national guidelines for albumin use. A lack of evidence supporting albumin use in cardiac surgical patients, especially those at highest risk of complications, was a frequently identified concern. CONCLUSIONS: The majority of Canadian anesthesiologists and intensivists (62%) use albumin in cardiac surgical patients. There is clinical equipoise regarding its utility, and an acknowledged need for higher quality evidence to guide practice.
PURPOSE: To evaluate the perceptions and practices of Canadian cardiovascular anesthesiologists and intensivists towards intravenous albumin as a resuscitation fluid in patients undergoing cardiac surgery. METHODS: We conducted a cross-sectional survey of cardiac anesthesiologists and intensivists involved in the care of cardiac surgical patients. The 22-item survey included seven open-ended questions and assessed practice patterns and attitudes towards albumin. Descriptive statistics were analyzed using counts and proportions. Qualitative data were analyzed to identify themes describing albumin use patterns in Canada. RESULTS: A total of 133 respondents from seven provinces participated, with 83 (62%) using albumin perioperatively. The majority of respondents (77%) felt a low fluid balance in cardiac surgical patients was important, and that supplementing crystalloids with albumin was helpful for this objective (67%). There was poor agreement among survey respondents regarding the role of albumin for faster vasopressor weaning or intensive care discharge, and ≥ 90% did not feel albumin reduced mortality, renal injury, or coagulopathy. Nevertheless, cardiac surgical patients were identified as a distinct population where albumin may help to minimize fluid balance. There was an acknowledged paucity of formal evidence supporting possible benefits. Fewer than 10% of respondents could identify institutional or national guidelines for albumin use. A lack of evidence supporting albumin use in cardiac surgical patients, especially those at highest risk of complications, was a frequently identified concern. CONCLUSIONS: The majority of Canadian anesthesiologists and intensivists (62%) use albumin in cardiac surgical patients. There is clinical equipoise regarding its utility, and an acknowledged need for higher quality evidence to guide practice.
Authors: Paul A Harris; Robert Taylor; Brenda L Minor; Veida Elliott; Michelle Fernandez; Lindsay O'Neal; Laura McLeod; Giovanni Delacqua; Francesco Delacqua; Jacqueline Kirby; Stephany N Duda Journal: J Biomed Inform Date: 2019-05-09 Impact factor: 6.317
Authors: Carol Bennett; Sara Khangura; Jamie C Brehaut; Ian D Graham; David Moher; Beth K Potter; Jeremy M Grimshaw Journal: PLoS Med Date: 2011-08-02 Impact factor: 11.069