Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials

Background Small-volume resuscitation can rapidly correct
hypovolemia. Hyperoncotic albumin solutions, long in clinical use,
are suitable for small-volume resuscitation; however, their
clinical benefits remain uncertain. Methods Randomized clinical
trials comparing hyperoncotic albumin with a control regimen for
volume expansion were sought by multiple methods, including
computer searches of bibliographic databases, perusal of reference
lists, and manual searching. Major findings were qualitatively
summarized. In addition, a quantitative meta-analysis was performed
on available survival data. Results In all, 25 randomized clinical
trials with a total of 1,485 patients were included. In surgery,
hyperoncotic albumin preserved renal function and reduced
intestinal edema compared with control fluids. In trauma and
sepsis, cardiac index and oxygenation were higher after
administration of hydroxyethyl starch than hyperoncotic albumin.
Improved treatment response and renal function, shorter hospital
stay and lower costs of care were reported in patients with liver
disease receiving hyperoncotic albumin. Edema and morbidity were
decreased in high-risk neonates after hyperoncotic albumin
administration. Disability was reduced by therapy with hyperoncotic
albumin in brain injury. There was no evidence of deleterious
effects attributable to hyperoncotic albumin. Survival was
unaffected by hyperoncotic albumin (pooled relative risk, 0.95; 95%
confidence interval 0.78 to 1.17). Conclusion In some clinical
indications, randomized trial evidence has suggested certain
benefits of hyperoncotic albumin such as reductions in morbidity,
renal impairment and edema. However, further clinical trials are
needed, particularly in surgery, trauma and sepsis.