Albumin as Early Fluid Bolus Therapy after Cardiac Surgery in the Critical Care Units

Abstract

Abstract Introduction After cardiac surgery, the use of intravenous fluids to reach specific goals is associated with improved clinical outcomes and shortened intensive care units (ICU) stay. Although type of fluid doesn’t seem to be of a great importance. Clinicians will have been involved in many local debates about the best fluid. Absence of evidence about what is the ideal fluid in this situation push researchers to conduct clinical trials in this context. Aim of the Work The aim of this study is to investigate the cardiovascular effect of using 20% albumin in patients after cardiac surgery. Methods This was a double blinded RCT that was conducted at Department of Critical Care Medicine, Ain Shams University Hospital over 6 months on post-cardiac surgery mechanically ventilated patients with a clinical decision to administer fluid bolus therapy, that was assessed for enrollment. Results There was no statistically significant difference between two groups regarding delta serum chloride at 24 h post-op (mmol/L) and renal replacement therapy post-operatively in ICU, and there was statistically significant difference found between two groups regarding ICU, and Hospital stay, duration of mechanical ventilation, total dose nor epinephrine/kg in the first 24 h post-op (microg/kg), time to cessation of nor epinephrine infusion (h) and Delta serum creatinine at 24 h post-op (mg/dl). Conclusion In patients admitted to ICU following cardiac surgery, FBT with 20% albumin, when compared to crystalloid FBT, achieved equivalent cardiovascular optimization with smaller volumes of resuscitation fluid, less positive cumulative balance, and without evidence of any negative sequelae. Moreover, the use of 20% albumin for FBT was associated with lower amounts of vasopressor being delivered and shorter duration.