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Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials.
Crit Care. 2008;12(2):R34. Epub 2008 Mar 4.
Jacob M, Chappell D, Conzen P, Wilkes MM, Becker BF, Rehm M.
Klinik
für Anästhesiologie, Ludwig-Maximilians-Universität, Klinikum
Grosshadern, Nussbaumstrasse 20, D-80336 Munich, Germany.
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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.
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