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Randomized Controlled Trial
. 2024 Feb 5;28(1):39.
doi: 10.1186/s13054-024-04821-6.

Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial

Affiliations
Randomized Controlled Trial

Blood volume and hemodynamics during treatment of major hemorrhage with Ringer solution, 5% albumin, and 20% albumin: a single-center randomized controlled trial

François Jardot et al. Crit Care. .

Abstract

Background: Volume replacement with crystalloid fluid is the conventional treatment of hemorrhage. We challenged whether a standardized amount of 5% or 20% albumin could be a viable option to maintain the blood volume during surgery associated with major hemorrhage. Therefore, the aim of this study was to quantify and compare the plasma volume expansion properties of 5% albumin, 20% albumin, and Ringer-lactate, when infused during major surgery.

Methods: In this single-center randomized controlled trial, fluid replacement therapy to combat hypovolemia during the hemorrhagic phase of cystectomy was randomly allocated in 42 patients to receive either 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 min at the beginning of the hemorrhagic phase, both completed by a Ringer-lactate replacing blood loss in a 1:1 ratio, or Ringer-lactate alone to replace blood loss in a 3:1 ratio. Measurements of blood hemoglobin over 5 h were used to estimate the effectiveness of each fluid to expand the blood volume using the following regression equation: blood loss plus blood volume expansion = factor + volume of infused albumin + volume of infused Ringer-lactate.

Results: The median hemorrhage was 848 mL [IQR: 615-1145]. The regression equation showed that the Ringer-lactate solution expanded the plasma volume by 0.18 times the infused volume while the corresponding power of 5% and 20% albumin was 0.74 and 2.09, respectively. The Ringer-lactate only fluid program resulted in slight hypovolemia (mean, - 313 mL). The 5% and 20% albumin programs were more effective in filling the vascular system; this was evidenced by blood volume changes of only + 63 mL and - 44 mL, respectively, by long-lasting plasma volume expansion with median half time of 5.5 h and 4.8 h, respectively, and by an increase in the central venous pressure.

Conclusion: The power to expand the plasma volume was 4 and almost 12 times greater for 5% albumin and 20% albumin than for Ringer-lactate, and the effect was sustained over 5 h. The clinical efficacy of albumin during major hemorrhage was quite similar to previous studies with no hemorrhage.

Trial registration: ClinicalTrials.gov NCT05391607, date of registration May 26, 2022.

Keywords: 20% albumin; 5% albumin; Fluid therapy; Hemorrhage; Plasma volume expansion; Ringer-lactate.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of the procedure
Fig. 2
Fig. 2
CONSORT flow chart
Fig. 3
Fig. 3
A Blood volume trends for the three infusion strategies. Mean values are shown. B Multiple regression analysis used to obtain the plasma volume expanding power of the three infusion fluids. The equation is shown on top. C Blood volumes changes according to the cumulating hemorrhage illustrates the overall pattern of hypovolemia/hypervolemia in the study
Fig. 4
Fig. 4
Blood loss and the volume contribution of each infusion fluid to how well the BV was maintained. The top curve in each subplot represents the BV change. The data are the mean with standard deviation
Fig. 5
Fig. 5
Cardiac output (A), mean arterial pressure (B), and central venous pressure (C). The data are presented with the standard error of the mean
Fig. 6
Fig. 6
Crude data used the calculation of T1/2 for 5% and 20% albumin are shown in subplots (A) and (C). The T1/2 were then obtained as the k-value for the regression slope connecting the mean values for the ln-transformed the volume expansion over time. B The k-value for 5% albumin was − 0.126, which corresponds to a T1/2 of 5.5 h. D The k-value for 20% albumin was − 0.144, which corresponds to a T1/2 of 4.8 h

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