Use or Misuse of Albumin in Critical Ill Patients

Abstract

Since 1940 albumin has been used worldwide and is widely available commercially since this time. However, a meta-analysis in 1998 challenged the use of albumin and identified a trend toward higher mortality in critically ill patients who had received albumin. Since then, many studies including multicenter randomized controlled trials have been carried out investigating the safety and efficacy of albumin treatment in different patient cohorts. In this context, patient cohorts that benefit from albumin were identified. However, particularly in non-liver patients, the use of albumin remains controversial. In our comprehensive review, we would like to highlight the most important studies in the recent 20 years and therefore offer an evidence-based outlook for the use of albumin for patients treated in the ICU.

Keywords: cirrhosis; hemodynamic; immunology; sepsis; volume treatment.

Figure 1

Interaction between endothelial cells, glycocalyx, albumin, and the interstitial space. The current understanding of vascular barrier function in the high-pressure segment of the vascular system includes an intact glycocalyx. Intact glycocalyx barrier competence is preserved even at albumin concentrations < 10 g/L. The green arrow shows the colloid oncotic pressure keeping fluid in the vascular lumen, while the blue arrow demonstrates the driving pressure out of the vessel. The thin purple arrow shows the transcapillary fluid flow, which results from a complex interaction of endothelial cells, glycocalyx, and albumin.