Fluid administration is a key intervention in hemodynamic
resuscitation. Timely expansion (or restoration) of plasma volume may prevent tissue
hypoxia and help to preserve organ function. In
septic shock in particular, delaying fluid
resuscitation may be associated with
mitochondrial dysfunction and may promote
inflammation. Ideally, infused fluids should remain in the plasma for a prolonged period.
Colloids remain in the intravascular space for longer periods than do crystalloids, although their hemodynamic effect is affected by the usual metabolism of
colloid substances; leakage through the endothelium in conditions with increased permeability, such as
sepsis; and/or external losses, such as with
hemorrhage and
burns.
Albumin has pleiotropic physiological activities including
antioxidant effects and positive effects on vessel wall integrity. Its administration facilitates achievement of a negative fluid balance in
hypoalbuminemia and in conditions associated with
edema. Fluid
resuscitation with
human albumin is less likely to cause nephrotoxicity than with artificial
colloids, and
albumin infusion has the potential to preserve renal function in
critically ill patients. These properties may be of clinical relevance in circulatory
shock, capillary leak,
liver cirrhosis, and de-escalation after volume
resuscitation.
Sepsis is a candidate condition in which
human albumin infusion to preserve renal function should be substantiated.