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Randomized Controlled Trial
. 2024 Jul;50(7):1075-1085.
doi: 10.1007/s00134-024-07488-3. Epub 2024 Jul 2.

Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial

Geoffrey J Wigmore  1   2 , Adam M Deane  3   4 , Jeffrey J Presneill  3   4   5 , Glenn Eastwood  6 , Ary Serpa Neto  3   5   6   7 , Matthew J Maiden  3   4   8 , Shailesh Bihari  9   10 , Robert A Baker  11 , Jayme S Bennetts  11 , Rashmi Ghanpur  12 , James R Anstey  4 , Jaishankar Raman  6   13   14 , Rinaldo Bellomo  3   4   5   6   15 ; HAS FLAIR-II investigators
Collaborators, Affiliations
Randomized Controlled Trial

Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial

Geoffrey J Wigmore et al. Intensive Care Med. 2024 Jul.

Abstract

Purpose: After cardiac surgery, fluid bolus therapy (FBT) with 20% human albumin may facilitate less fluid and vasopressor administration than FBT with crystalloids. We aimed to determine whether, after cardiac surgery, FBT with 20% albumin reduces the duration of vasopressor therapy compared with crystalloid FBT.

Methods: We conducted a multicentre, parallel-group, open-label, randomised clinical trial in six intensive care units (ICUs) involving cardiac surgery patients deemed to require FBT. We randomised 240 patients to receive up to 400 mL of 20% albumin/day as FBT, followed by 4% albumin for any subsequent FBT on that day, or to crystalloid FBT for at least the first 1000 mL, with use of crystalloid or 4% albumin FBT thereafter. The primary outcome was the cumulative duration of vasopressor therapy. Secondary outcomes included fluid balance.

Results: Of 480 randomised patients, 466 provided consent and contributed to the primary outcome (mean age 65 years; median EuroSCORE II 1.4). The cumulative median duration of vasopressor therapy was 7 (interquartile range [IQR] 0-19.6) hours with 20% albumin and 10.8 (IQR 0-22.8) hours with crystalloids (difference - 3.8 h, 95% confidence interval [CI] - 8 to 0.4; P = 0.08). Day one fluid balance was less with 20% albumin FBT (mean difference - 701 mL, 95% CI - 872 to - 530).

Conclusions: In patients after cardiac surgery, when compared to a crystalloid-based FBT, 20% albumin FBT was associated with a reduced positive fluid balance but did not significantly reduce the duration of vasopressor therapy.

Keywords: Albumin; Cardiac surgery; Critical care; Fluid therapy; Resuscitation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
HAS FLAIR-II trial consort diagram
Fig. 2
Fig. 2
Vasopressor duration. A Distributions of vasopressor hours by study group as the cumulative proportion (y-axis) for each study group by hours (x-axis). Curves that rise faster are more favourable. B Vasopressor hours as horizontally stacked proportions by study group. Red represents better values and blue represents worse values
See this image and copyright information in PMC

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