Albumin as resuscitation fluid for septic shock: Review

ABC-SEPSIS trial adds to aging body of evidence

Albumin is a protein produced by the liver whose molecular weight and negative charge attract sodium cations, and with them water molecules. In this way albumin produces most of the vascular system’s oncotic pressure—the force tending to retain fluid in blood vessels without its leaking into the extravascular space. This increases mean arterial pressure.

Albumin has thus been a physiologically attractive therapy as a resuscitation fluid for hypotensive critically ill patients.

How well does it work?

RCTs for Albumin as Resuscitation Fluid

Two large international randomized trials (SAFE using a 4% concentration, ALBIOS using 20%) did not show any benefit of albumin for resuscitation in critical illness:

A third large multicenter randomized trial (EARSS) enrolled 792 patients and was terminated early (partially due to insufficient patient recruitment). Some of its initial results were presented at a 2011 conference but were never published in a journal.

CRISTAL, another large international randomized trial (Annane et al JAMA 2013) did not show a benefit of colloids as compared to crystalloids. However, the colloid arm consisted of a mix of patients receiving hydroxyethyl starch (later shown to be harmful) or albumin, limiting any conclusions about albumin per se.

Bring In the Meta-Analyses