Albumin for resuscitation and volume expansion in critically ill patients

Evidence Summaries

Level of Evidence = B

Albumin administration appears not to reduce mortality in patients with hypovolaemia or in critically ill patients with burns and hypoalbuminaemia.

A Cochrane review 1 included 38 trials reporting death as outcome. There were 1,958 deaths among 10,842 trial participants. For hypovolaemia, the relative risk of death following albumin administration was 1.02 (95% CI 0.92 to 1.13). This estimate was heavily influenced by the results of the SAFE trial which contributed 75.2% of the information (based on the weights in the meta-analysis). For burns, the relative risk was 2.93 (95% CI 1.28 to 6.72) and for hypoalbuminaemia the relative risk was 1.26 (95% CI 0.84 to 1.88). There was no substantial heterogeneity between the trials in the various categories. The pooled relative risk of death with albumin administration was 1.05 (95% CI 0.95 to 1.16).

Comment: The quality of evidence is downgraded by study limitations (inadequate allocation concealment). The possibility that there may be highly selected populations of critically ill patients in which albumin may be indicated remains open to question.

References

1. Roberts I, Blackhall K, Alderson P et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2011;(11):CD001208.  [PMID:22071799]


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