Therapeutic influence of 20 % albumin versus 6% hydroxyethylstarch on extravascular lung water in septic patients: a randomized controlled trial.
OBJECTIVE
Recent studies demonstrated that extravascular lung water (EVLW) is a reliable and independent marker for outcome. The primary therapeutically goal in critically ill patients is to resuscitate and retain adequate organ perfusion by fluid administration, where is necessary to achieve adequate intravascular filling, but avoid initiation of pulmonary edema.


METHODS
Patients with severe sepsis were randomly allocated to a group treated with 20% Albumin 100 ml every 12 hours (ALB; n = 30) or with 6% hydroxyethylstarch 130/0, 4 250 ml every 6 hours (HES; n = 26). Both treatments were completed by crystalloids or norephinephrin as necessary. We analyzed amount of developed EVLW, and relation with mortality, PaO2/FiO2 and alveolo-arterial oxygen difference.


RESULTS
We observed significantly greater decrease of EVLW when compared with baseline during whole monitored period of 72 hours in ALB group in contrast to HES patients (p < 0.05). Despite no significant changes of EVLW in HES group, we noted improve of PaO2/FiO2 and AaDO2 in both groups. We did not observed significant difference in mortality.


CONCLUSIONS
The present study results show can summarize that albumin reduces in a higher amount and earlier the extravascular lung water than HES, but this reduction was not associated with improvement of oxygenation functions, which was better in HES group.
Dolecek
Martin
M
Trauma Hospital Brno, Czech Republic.
Svoboda
Petr
P
Kantorová
Ilona
I
Scheer
Peter
P
Sas
Igor
I
Bíbrová
Jitka
J
Radvanova
Jana
J
Radvan
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage*; D002199:Capillary Permeability; D015633:Extravascular Lung Water / Q000187:drug effects*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011654:Pulmonary Edema / Q000517:prevention & control; D018805:Sepsis / Q000503:physiopathology / Q000628:therapy*; D012709:Serum Albumin / Q000032:analysis
D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D012709:Serum Albumin; D010100:Oxygen