Introduction
Methods
Objectives
Inclusion criteria
Identification of studies
Data extraction
Quality assessment
Statistical analysis
Results
Included trials
Trial | n | Indication | Regimen | Results |
---|---|---|---|---|
Cardiac surgery | ||||
Boldt et al., 1986 [37] | 55 | Coronary artery bypass grafting | 300 ml 20% albumin intraoperatively after bypass vs 500 ml 3% HES 200/0.5 vs 500 ml 3.5% gelatin vs no additional volume | Post-bypass COP rebound greater in albumin than other groups (p < 0.05) |
Boldt et al., 1993 [41] | 30 | Cardiac defect repair in children < 3 years old | 20% albumin vs 6% HES 200/0.5 to stabilize hemodynamics before bypass | On-bypass urine output in HES group lower by 57% than that of albumin group (p < 0.05) |
Magder and Lagonidis, 1999 [52] | 28 | Stable patients after cardiac bypass surgery | 100 ml 25% albumin vs saline to increase right atrial pressure by 2 mm Hg | Greater increase in cardiac output among hyperoncotic albumin recipients, suggesting an inotropic effect |
Non-cardiac surgery | ||||
Zetterström and Hedstrand, 1981 [36] | 30 | Elective major abdominal surgery | 300–400 ml 20% albumin on operation day, 200 ml on next day and 100 ml/day for subsequent 3 days vs no albumin | In albumin recipients COP significantly closer to preoperative level on postoperative days 2–6 |
Prien et al., 1990 [39] | 18 | Abdominal surgery | 20% albumin vs 10% HES 200/0.5 vs Ringer's lactate to maintain preoperative CVP | Significantly lower intraoperative intestinal edema after albumin compared with either HES or Ringer's lactate; impaired coagulation in HES recipients |
Trauma | ||||
Boldt et al., 1995 [44] | 30 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | No between-group differences in daily profiles of plasma thrombomodulin, proteins C and S and thrombin-antithrombin III |
Boldt et al., 1996 [45] | 30 | Trauma of ISS between 15 and 30 | 20% albumin vs 10% HES 200/0.5 to 12–18 mm Hg target PCWP | HES 200/0.5 but not albumin increased cardiac index, PaO2/FiO2, DO2I and VO2I (p < 0.05 for all comparisons) |
Boldt et al., 1996 [46] | 28 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | Maximum platelet aggregation declined in both groups (p < 0.05) |
Boldt et al., 1996 [48] | 28 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 10–15 mm Hg target PCWP | Vasopressin decreased in HES 200/0.5 but not albumin group (p < 0.05) |
Boldt et al., 1998 [49] | 150 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–15 mm Hg target PCWP | PaO2/FiO2 increased by HES 200/0.5 but not albumin (p < 0.05); higher cardiac index, DO2I and VO2I in HES 200/0.5 group (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT |
Trial | n | Indication | Regimen | Results |
---|---|---|---|---|
Boldt et al., 1995 [44] | 30 | Sepsis after major surgery | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | Plasma thrombomodulin increased in albumin group and remained unchanged in HES 200/0.5 group (p < 0.05); plasma protein C among HES 200/0.5 recipients increased on days 4 and 5 without corresponding change in albumin group (p < 0.05) |
Boldt et al., 1996 [45] | 30 | Sepsis secondary to major general surgery | 20% albumin vs 10% HES 200/0.5 to 12–18 mm Hg target PCWP | HES 200/0.5 but not albumin increased cardiac index, RVEF, PaO2/FiO2, DO2I and VO2I and decreased SVRI (p < 0.05 for all comparisons); pHi decreased in albumin but not HES 200/0.5 group (p < 0.05) |
Boldt et al., 1996 [46] | 28 | Sepsis after major surgery | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | Maximum platelet aggregation declined in both groups (p < 0.05) |
Boldt et al., 1996 [47] | 42 | Sepsis secondary to major surgery | 20% albumin vs 6% HES 200/0.5 vs pentoxyfylline (300 mg bolus plus 1.4 mg/kg/h continuous infusion) | Circulating sELAM-1 and sICAM-1 concentrations reduced by HES 200/0.5 compared with albumin (p < 0.05 for both comparisons) |
Boldt et al., 1996 [48] | 28 | Sepsis secondary to major surgery | 20% albumin vs 10% HES 200/0.5 to 10–15 mm Hg target PCWP | Vasopressin, endothelin-1, norepinephrine and 6-keto-prostaglandin F1a decreased and pHi increased in HES 200/0.5 but not albumin group (p < 0.05 for all comparisons); ANP increased by albumin but not HES 200/0.5 (p < 0.05) |
Boldt et al., 1998 [49] | 150 | Postoperative sepsis | 20% albumin vs 10% HES 200/0.5 to 12–15 mm Hg target PCWP | PaO2/FiO2 increased and lactate decreased by HES 200/0.5 but not albumin (p < 0.05 for both comparisons); higher cardiac index, DO2I and VO2I in HES 200/0.5 group (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT |
Palumbo et al., 2006 [59] | 20 | Severe sepsis | 20% albumin vs 6% HES 130/0.4 | PCWP of 15–18 mm Hg successfully maintained by both colloids throughout the 5-day study period; temperature, MAP, pulmonary artery pressure, CVP, heart rate and urine output remained stable in both groups; HES increased cardiac index and several oxygenation parameters and decreased APACHE II score |
Trial | n | Indication | Regimen | Results |
---|---|---|---|---|
Liver disease | ||||
Gentilini et al., 1999 [51] | 126 | Cirrhosis and refractory ascites | Inpatient treatment with 12.5 g/day 25% albumin plus diuretics vs diuretics alone | 90.5% cumulative treatment response rate in group receiving albumin vs 74.7% in control group (p < 0.05); shorter hospital stay (p < 0.05) in group receiving albumin (20 vs 24 days) resulting in 59% cost savings; no survival difference |
Sort et al., 1999 [53] | 126 | Cirrhosis with ascites and spontaneous bacterial peritonitis | 1.5 g/kg 20% albumin within 6 h of diagnosis and 1 g/kg on day 3 vs no albumin; intravenous cefotaxime in both groups | Renal impairment in 33% of control group vs 10% of albumin recipients (p = 0.002); 29% hospital mortality in control group vs 10% of group receiving albumin (p = 0.01); 41% and 22% mortality, respectively, by 3 months of follow-up (p = 0.03) |
Fernández et al., 2005 [58] | 20 | Cirrhosis and spontaneous bacterial peritonitis | 20% albumin vs 6% HES 200/0.5, both administered at 1.5 g/kg after baseline measurements and 1.0 g/kg on day 3 | Albumin increased mean arterial pressure and decreased plasma renin activity; no improvements in circulatory function in patients receiving HES; 4 of 10 HES recipients developed spontaneous bacterial peritonitis-induced circulatory dysfunction or renal failure, whereas neither complication occurred in any of the 10 patients receiving albumin |
High-risk neonates | ||||
McMurray et al., 1948 [35] | 33 | Premature infants with low birth weight | 3 ml 25 g/dl albumin injected per pound body weight 1–2 times weekly vs no albumin | 8.5 days shorter mean time to regain birth weight in infants receiving albumin (p = 0.02) and significantly fewer illnesses |
Greenough et al., 1993 [42] | 30 | Ventilator-dependent ill pre-term infants | 5 ml/kg 20% albumin vs placebo | Albumin reduced edema based on weight loss (p < 0.01), whereas control group gained weight (p < 0.05); 27% reduction in inspired oxygen requirement after albumin treatment (p < 0.05) with no change in control group |
Gürkan et al., 2001 [56] | 18 | Newborns with asphyxia and brain edema | 0.5 g/kg 20% albumin vs routine fluid | Higher modified Apgar score in group receiving albumin after 24 h (p < 0.001) with difference persisting 8 days; cerebral edema reduced in greater proportion of albumin than control group as judged by head ultrasound; 28% shorter hospital stay in albumin-treated group (p < 0.01) |
Brain injury | ||||
Goslinga et al., 1992 [40] | 300 | Acute ischemic stroke | Normovolemic hemodilution with 20% albumin vs crystalloids | In subgroup with normal hematocrit accounting for two-thirds of study population, mortality and disability at 3 months significantly lower among albumin recipients |
Tomita et al., 1994 [43] | 18 | Closed head injury | High-oncotic-pressure therapy with 25% albumin and furosemide vs normal-oncotic-pressure therapy | Recovery with minimal or no neurological deficit in patients of high-oncotic-pressure therapy group; persistent vegetative state or death in 30% of patients receiving normal-oncotic-pressure therapy |
Intradialytic hypotension | ||||
van der Sande et al., 1999 [54] | 10 | Crossover trial of stable dialysis patients | 20% albumin vs 10% HES 200/0.5 vs saline, in conjunction with ultrafiltration and hemodialysis | Greater decrease in blood volume with saline than other fluids (p < 0.05) |
van der Sande et al., 2000 [55] | 9 | Crossover trial of cardiac-compromised dialysis patients | 100 ml of 20% albumin vs 10% HES 200/0.5 vs 3% hypertonic saline, in conjunction with ultrafiltration and hemodialysis | Greater intradialytic reductions in systolic blood pressure (p < 0.05) and blood volume (p < 0.05) with hypertonic saline than either albumin or HES |
Nephrotic syndrome | ||||
Kosnadi et al., 1987 [38] | 24 | Children with nephrotic syndrome | 20% albumin + furosemide + prednisone vs human plasma + furosemide + prednisone vs prednisone alone | Diuresis earlier with albumin + furosemide + prednisone vs prednisone alone (p = 0.011) and percent body weight loss greater (p < 0.01) |
Fliser et al., 1999 [50] | 9 | Double-blind, placebo-controlled crossover trial in patients with nephrotic syndrome on standardized salt intake | 200 ml 20% albumin + 0.9% NaCl sham infusion vs 200 ml 20% albumin + 60 mg furosemide vs 60 mg furosemide + sham infusion of 200 ml H2O | Urinary volume and sodium excretion higher by 20% (p < 0.05 and p < 0.01, respectively) during first 8 h with albumin + furosemide than furosemide alone |
Na et al., 2001 [57] | 7 | Crossover trial in patients with nephrotic syndrome | 100 ml 20% albumin vs 5% dextrose followed by 160 mg of furosemide | Albumin potentiated the diuretic effect of furosemide |