Health & Medical intensive care

Ask the Experts - IV Albumin and Sepsis

´╗┐Ask the Experts - IV Albumin and Sepsis
In severe sepsis, there is associated endothelial-cell contraction leading to capillary leak syndrome. In such circumstances, are we justified in giving intravenous albumin?

B. Ravinder Reddy, MBBS, MS, FRCS (Edin), FRCS (Glas)

Your question is a good one, and very timely. At this time, there are essentially no indications for the use of intravenous albumin in patients with sepsis syndrome. As you state, these patients have increased capillary permeability, and any colloid that is administered rapidly finds its way into the extravascular space where it can prolong or worsen edema. This is particularly problematic in the lung. There have been 2 recent meta-analyses of the use of colloids, and both failed to identify any benefit. Use of intravenous albumin or artificial colloids cannot be recommended in septic patients.

There are 2 specific patient populations that may benefit from the use of albumin or artificial colloids, such as hetastarch. The first is patients with spontaneous bacterial peritonitis, in whom one study identified benefit with resuscitation with 5% albumin. The other population is patients undergoing specific surgical procedures associated with massive transfusion, for example major spine surgery in which the judicious use of colloids may prevent edema formation and allow these patients to be extubated at the end of the procedure, rather than being kept intubated because of upper airway edema. Note that these surgical patients should have normal vascular permeability. In any case, these solutions are quite expensive, and their additional cost over crystalloid solutions should be carefully considered.

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