Abstract
BackgroundThe drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation.MethodsThis was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine.ResultsFractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001).ConclusionTwo days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored.Trial Registrationclinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492
Highlights
Intravenous fluids are a cornerstone of the management of hypovolemia in connection with surgery, but the choice of fluid and the amount to be given is subject to a vigorous debate [1,2,3,4]
Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, transcapillary escape rate (TER) and plasma volume as compared with values obtained immediately pre-operatively
The physiological importance of low plasma albumin concentration (P-Alb) is unclear, but a value below 25 g/L on the first postoperative day is a predictor of pancreatic fistula and major complications after pancreaticduodenectomy [13]
Summary
Intravenous fluids are a cornerstone of the management of hypovolemia in connection with surgery, but the choice of fluid and the amount to be given is subject to a vigorous debate [1,2,3,4]. The preservation of colloid osmotic pressure during surgery by albumin reduced intestinal oedema [9], albumin infusions after the end of surgery have failed to show any benefit for the patients [10, 11] It remains unclear if albumin has a place in fluid treatment in the operating room. The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation
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