Isooncotic human albumin
The theoretical value of fluid therapy with isooncotic human albumin
over crystalloids is multifactorial [20, 27, 42]. Physiologically,
albumin is the primary determinant of intravascular osmotic pressure,
aids in the transport of several compounds, serves as a native free
radical scavenger and possess both anti-inflammatory and antioxidant
properties [27, 42-44].
As a volume expander, isooncotic human albumin is theorized to provide
intravascular volume expansion more efficiently than crystalloids
[24]. Colloids are hypothesized to remain in the intravascular space
for a more sustained period of time [25, 45], and provide volume
expansion without a significant chloride burden when compared to both
isotonic saline and balanced crystalloid solutions [20, 27]. The
latter is particularly relevant given the growing body of evidence that
indicates elevated chloride levels are harmful in the critically ill
[46-48].
The potential risks of resuscitation in the ICU with human albumin has
also been investigated [49-51]. When compared to crystalloids, there
is evidence to suggest resuscitation with human albumin may be related
to coagulation abnormalities [50], increased need for blood
transfusions [50, 52], anaphylactoid reactions [40], and acute
kidney injury [51, 53]. Moreover, there has been no consistent
evidence that suggests resuscitation with albumin improves mortality,
number of ventilator free days or length of hospital stay [52]. In
addition to these potential clinical sequelae, human albumin costs
significantly more in comparison to saline and balanced intravenous
fluids [12, 49, 52].