After 40 years in this profession, I find it amusing how we keep trying to prove that albumin is of use for almost any condition, outside of specific circumstances involving cirrhotic patients. "It just makes SO much sense. It HAS to work." For my entire career people have been trying to prove that it works, and I do mean that it was an argument even when I was a medical student and before I actually had a career. There must be big profits in it; what other drug do you know that has failed over and over to show efficacy but is still marketed? For heaven's sake, drotrecogin alpha at least had one study that demonstrated a survival benefit, and it doesn't even exist any more. I love how the nephrologists persist in believing that albumin helps with dialysis and/or diuresis. Which it might do, but in our critical care patients all it evidently does is prolong the inevitable at great expense. The notion is so tempting that "we" keep doing trial after trial. The outcomes of the ICARUS-ED trial are non-sequiturs; unless they translate to a survival benefit, they mean nothing. I suppose I understand publishing the data, from an academic standpoint. It does seem fair that unless you can show these intermediate outcomes, you clearly will not be able to show a mortality outcome. If it spurs another multimillion dollar, multi-center RCT, perhaps it has some utility. At least we will be just about out of permutations on the theme. If it works, great. If it doesn't, I'm not sure where else we'll turn in the quest to prove that IT REALLY DOES WORK! The sirens keep calling...
If they use less vasopressors and have less organ failure, isn't this success? Why do we always use mortality as an endpoint? If the ones who end up surviving do so with less damage, isn't this a good thing?
Albumin can certainly last longer than crystalloids and would be possibly useful in pathologies that reverse quickly. this is certainly case with hypovolemic shock. I would like to think that it may be useful in those septic patients who get better quickly - e.g. UTI, urologic stenting etc. Since the population of these studies is so heterogeneous, its difficult to draw this conclusion. There would be certain population in sepsis who will benefit but we need to find those. I am always disappointed that we keep on repeating similar studies without going into nuances. I understand that they will be difficult to conduct and take longer and have lower power.
After 40 years in this profession, I find it amusing how we keep trying to prove that albumin is of use for almost any condition, outside of specific circumstances involving cirrhotic patients. "It just makes SO much sense. It HAS to work." For my entire career people have been trying to prove that it works, and I do mean that it was an argument even when I was a medical student and before I actually had a career. There must be big profits in it; what other drug do you know that has failed over and over to show efficacy but is still marketed? For heaven's sake, drotrecogin alpha at least had one study that demonstrated a survival benefit, and it doesn't even exist any more. I love how the nephrologists persist in believing that albumin helps with dialysis and/or diuresis. Which it might do, but in our critical care patients all it evidently does is prolong the inevitable at great expense. The notion is so tempting that "we" keep doing trial after trial. The outcomes of the ICARUS-ED trial are non-sequiturs; unless they translate to a survival benefit, they mean nothing. I suppose I understand publishing the data, from an academic standpoint. It does seem fair that unless you can show these intermediate outcomes, you clearly will not be able to show a mortality outcome. If it spurs another multimillion dollar, multi-center RCT, perhaps it has some utility. At least we will be just about out of permutations on the theme. If it works, great. If it doesn't, I'm not sure where else we'll turn in the quest to prove that IT REALLY DOES WORK! The sirens keep calling...
https://www.youtube.com/watch?v=VbOPpgrTXh8
If they use less vasopressors and have less organ failure, isn't this success? Why do we always use mortality as an endpoint? If the ones who end up surviving do so with less damage, isn't this a good thing?
Albumin can certainly last longer than crystalloids and would be possibly useful in pathologies that reverse quickly. this is certainly case with hypovolemic shock. I would like to think that it may be useful in those septic patients who get better quickly - e.g. UTI, urologic stenting etc. Since the population of these studies is so heterogeneous, its difficult to draw this conclusion. There would be certain population in sepsis who will benefit but we need to find those. I am always disappointed that we keep on repeating similar studies without going into nuances. I understand that they will be difficult to conduct and take longer and have lower power.