Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials.
BACKGROUND
Small-volume resuscitation can rapidly correct hypovolemia. Hyperoncotic albumin solutions, long in clinical use, are suitable for small-volume resuscitation; however, their clinical benefits remain uncertain.


METHODS
Randomized clinical trials comparing hyperoncotic albumin with a control regimen for volume expansion were sought by multiple methods, including computer searches of bibliographic databases, perusal of reference lists, and manual searching. Major findings were qualitatively summarized. In addition, a quantitative meta-analysis was performed on available survival data.


RESULTS
In all, 25 randomized clinical trials with a total of 1,485 patients were included. In surgery, hyperoncotic albumin preserved renal function and reduced intestinal edema compared with control fluids. In trauma and sepsis, cardiac index and oxygenation were higher after administration of hydroxyethyl starch than hyperoncotic albumin. Improved treatment response and renal function, shorter hospital stay and lower costs of care were reported in patients with liver disease receiving hyperoncotic albumin. Edema and morbidity were decreased in high-risk neonates after hyperoncotic albumin administration. Disability was reduced by therapy with hyperoncotic albumin in brain injury. There was no evidence of deleterious effects attributable to hyperoncotic albumin. Survival was unaffected by hyperoncotic albumin (pooled relative risk, 0.95; 95% confidence interval 0.78 to 1.17).


CONCLUSIONS
In some clinical indications, randomized trial evidence has suggested certain benefits of hyperoncotic albumin such as reductions in morbidity, renal impairment and edema. However, further clinical trials are needed, particularly in surgery, trauma and sepsis.
Jacob
Matthias
M
Klinik für Anästhesiologie, Ludwig-Maximilians-Universität, Klinikum Grosshadern, Nussbaumstrasse 20, D-80336 Munich, Germany. matthias.jacob@med.uni-muenchen.de
Chappell
Daniel
D
Conzen
Peter
P
Wilkes
Mahlon M
MM
Becker
Bernhard F
BF
Rehm
Markus
M
D000418:Albumins / Q000627:therapeutic use*; D004487:Edema / Q000517:prevention & control; D006801:Humans; D020896:Hypovolemia / Q000628:therapy*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation / Q000379:methods*; D012996:Solutions
D000418:Albumins; D010952:Plasma Substitutes; D012996:Solutions; C028426:hyperoncotic albumin