A comparison of the effects of different albumin solutions on severely ill adults in the intensive care unit.

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Background: Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of traumatic brain injury, FBT with human albumin solution appears safe and perhaps superior in severe sepsis/septic shock patients. However, 4% and 20% albumin solutions have different chloride contents and deliver different volumes. Objective: To compare the physiological and biochemical effects of FBT with 4% vs. 20% human albumin solution. Design: Retrospective observational study Setting: Tertiary intensive care unit Subjects: Critically ill patients receiving FBT with either 4% or 20% human albumin solution according to clinician preference Measurements and Main Results: We recorded demographic and clinical data for 202 patients (101 patients in each group). We obtained biochemical and hemodynamic data at baseline and at 1, 2 and 4 hours after the administration of either 4% or 20% human albumin solution. We compared the effect of FBT with the two solutions. Patients receiving 20% albumin had a higher incidence of pre-existing liver disease (P=0.003), were more likely to be on renal replacement therapy (P=0.005) and had higher APACHE III scores and predicted risk of death on admission (P=0.007 and <0.0001 respectively). Patients in the 4% group received a median volume of 500mls of albumin compared to 100mls in the 20% group (P<0.0001). There was a trend in higher mean arterial pressure values in the 20% group at 2 and 4 hours following the fluid bolus (P=0.056). There were no significant differences in absolute or percentage change of any haemodynamic parameters over the four hours following fluid bolus. Patients receiving 4% albumin demonstrated higher serum chloride levels and more negative bass excess (P =0.027 and 0.017, respectively). The difference in base excess was greater following post-hoc adjustment for risk of death (P=0.003/ 0.004) . Conclusions: FBT with 100 ml of 20% human albumin solution is hemodynamically equivalent to FBT with 500 ml of 4% human albumin solution but has a lesser effect on chloride levels and delivers 80% less fluid.

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