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Long intravascular persistence of 20% albumin in postoperative patients

Hasselgren E et al
6 December, 2019  

While iso-oncotic albumin (5%) is widely used in surgical care for plasma volume support in case of hypovoelaemia and organ hypoperfusion, the hyperoncotic formulation (20%) is indicated to reduce oedema in normovolaemic patients.

However, inflammation and states of hypervolaemia may negatively affect its intravascular persistence due to endothelial glycocalyx shedding.

In this study, the authors sought to determine the pharmacological and volumetric profile of 20% albumin, infused at a constant rate for 30 minutes, in patients undergoing major abdominal surgery.

The infusion diluted plasma volume by almost twice the infused fluid volume in both patients and healthy volunteers, and no differences were seen in plasma volume expansion over time. The increase in plasma albumin observed after 30 minutes post-infusion was significantly greater for the group undergoing surgery than for the control group.

Longer intravascular persistence times were seen for overweight patients, but age and sex did not influence outcomes. Mean arterial pressure values were lower for postoperative patients versus volunteers before and after the infusion, and plasma C-reactive protein levels were higher, but the levels of glycocalyx shedding products in the plasma and urine did not differ significantly between groups.

These observations show that 20% albumin is a safe option in the postoperative period.