|
Randomized clinical trials of hyperoncotic albumin in surgery and trauma |
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| Trial |
n |
Indication |
Regimen |
Results |
|
|
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| Cardiac surgery |
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| Boldt et al., 1986 [37] |
55 |
Coronary artery bypass grafting |
300 ml 20% albumin intraoperatively after bypass vs 500 ml 3% HES 200/0.5 vs 500 ml 3.5% gelatin vs no additional volume |
Post-bypass COP rebound greater in albumin than other groups (p < 0.05) |
| Boldt et al., 1993 [41] |
30 |
Cardiac defect repair in children < 3 years old |
20% albumin vs 6% HES 200/0.5 to stabilize hemodynamics before bypass |
On-bypass urine output in HES group lower by 57% than that of albumin group (p < 0.05) |
| Magder and Lagonidis, 1999 [52] |
28 |
Stable patients after cardiac bypass surgery |
100 ml 25% albumin vs saline to increase right atrial pressure by 2 mm Hg |
Greater increase in cardiac output among hyperoncotic albumin recipients, suggesting an inotropic effect |
| Non-cardiac surgery |
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| Zetterström and Hedstrand, 1981 [36] |
30 |
Elective major abdominal surgery |
300–400 ml 20% albumin on operation day, 200 ml on next day and 100 ml/day for subsequent 3 days vs no albumin |
In albumin recipients COP significantly closer to preoperative level on postoperative days 2–6 |
| Prien et al., 1990 [39] |
18 |
Abdominal surgery |
20% albumin vs 10% HES 200/0.5 vs Ringer's lactate to maintain preoperative CVP |
Significantly lower intraoperative intestinal edema after albumin compared with either HES or Ringer's lactate; impaired coagulation in HES recipients |
| Trauma |
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| Boldt et al., 1995 [44] |
30 |
Trauma of ISS > 15 |
20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both |
No between-group differences in daily profiles of plasma thrombomodulin, proteins C and S and thrombin-antithrombin III |
| Boldt et al., 1996 [45] |
30 |
Trauma of ISS between 15 and 30 |
20% albumin vs 10% HES 200/0.5 to 12–18 mm Hg target PCWP |
HES 200/0.5 but not albumin increased cardiac index, PaO2/FiO2, DO2I and VO2I (p < 0.05 for all comparisons) |
| Boldt et al., 1996 [46] |
28 |
Trauma of ISS > 15 |
20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both |
Maximum platelet aggregation declined in both groups (p < 0.05) |
| Boldt et al., 1996 [48] |
28 |
Trauma of ISS > 15 |
20% albumin vs 10% HES 200/0.5 to 10–15 mm Hg target PCWP |
Vasopressin decreased in HES 200/0.5 but not albumin group (p < 0.05) |
| Boldt et al., 1998 [49] |
150 |
Trauma of ISS > 15 |
20% albumin vs 10% HES 200/0.5 to 12–15 mm Hg target PCWP |
PaO2/FiO2 increased by HES 200/0.5 but not albumin (p < 0.05); higher cardiac index, DO2I and VO2I in HES 200/0.5 group (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT |
|
aPTT, activated partial thromboplastin time; COP, colloid oncotic pressure; CVP, central venous pressure; DO2I, oxygen delivery index; HES, hydroxyethyl starch; ISS, injury severity score; PaO2/FiO2, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; VO2I, oxygen consumption index. | ||||
Jacob et al. Critical Care 2008 12:R34 doi:10.1186/cc6812 |
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