Abstract
The recent Cochrane report on albumin administration is analysed and criticised on the grounds of clinical methodology, content and interpretation. Although it is naïve and illogical to treat hypoalbuminaemia with albumin infusions, a more balanced view on the use of albumin for resuscitation in acute hypovolaemia is necessary. Once the acute phase of critical illness is past, interstitial volume is often expanded causing oedema, with a low plasma volume. We argue for the use of salt-poor albumin solutions in this situation and conclude that, on current evidence, the assertion that albumin should be avoided in all situations is irrational and untenable.
Highlights
Meta-analyses and systematic reviews are useful, but potentially dangerous tools in the present age of evidencebased medicine
There is no physiological logic in using albumin for hypoalbuminaemia, because it is plasma volume rather than protein concentration that is most clinically relevant
We accept that the weight of literature suggests at least that albumin has no advantage over crystalloid or other colloids in most cases, there may be specific instances in adults and in children where its use may be beneficial, and one recent paper [16] concerning its use in peritonitis in cirrhotic persons showed a clear reduction in mortality
Summary
Meta-analyses and systematic reviews are useful, but potentially dangerous tools in the present age of evidencebased medicine. This paper was included by the Cochrane reviewers in the hypovolaemia group even though the authors categorically state that ‘thirty-four treatment group patients (n = 37) received albumin for low levels postoperatively’ [13], clearly indicating that the study should have been analyzed in the hypoalbuminaemia group In none of these studies was mortality cited as a primary or even a secondary end-point. As Webb [15] recently indicated, most of the papers discussed in the Cochrane study were designed to assess the effects of various fluids on physiological variables, and were not designed to assess mortality He pointed out that a randomized controlled trial comparing one colloid with one crystalloid would require over 6500 patients to detect an excess mortality from colloid of 4% on the basis of the data presented in the Cochrane review. Studies comparing salt-poor albumin and plasma substitutes, titrated to physiological end-points, are needed in this situation
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