Albumin has been used for volume
resuscitation and supplementation in
critically ill patients for over 50 years. While regarded as a "gold standard"
colloid solution,
albumin is associated with substantial cost, and questions have been raised about its safety and efficacy. A large-scale randomised controlled trial (the Saline vs.
Albumin Fluid Evaluation [SAFE] study) demonstrated that
albumin and saline were clinically equivalent treatments for intravascular volume
resuscitation in a heterogenous population of
critically ill patients. However, in patients with
traumatic brain injury,
albumin was associated with a significantly higher mortality and cannot be recommended for acute
resuscitation of such patients. A potential beneficial role of
albumin in patients with
severe sepsis, particularly
malaria, requires further study. Extrapolation of the results of the SAFE study to other, synthetic,
colloid solutions requires caution, and a randomised controlled trial comparing
albumin,
starch and crystalloids in patients with
severe sepsis is warranted. The safety of synthetic
colloids in patients with
traumatic brain injury should not be assumed. Although hypoalbuminaemia is associated with increased mortality, use of
albumin for volume
resuscitation of
critically ill patients with a
serum albumin concentration < or =25 g/L is not associated with reductions in mortality, duration of ICU stay or
mechanical ventilation, or in use of
renal replacement therapy. Similarly, there is no substantive evidence to justify the use of
hyperoncotic albumin solutions for
resuscitation or supplementation in
critically ill patients.
Albumin is a safe and effective
resuscitation solution in
critically ill patients without
traumatic brain injury. However, the acquisition costs of
albumin and synthetic
colloids are more than those of crystalloids, and, as yet,
colloids have not been proven to confer substantive benefits over crystalloids such as saline.