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Recruitment of extravascular fluid by hyperoncotic albumin

Zdolsek M, Hahn RG, Zdolsek JH
4 December, 2019  

Hyperoncotic albumin has been traditionally used to mobilise oedematous fluid from the interstitium following fluid resuscitation procedures, but there is currently no robust clinical evidence of its benefits in the context of critical care.

This study describes the effects of 20% albumin on fluid recruitment from the interstitial and intracellular fluid spaces in 15 healthy euvolaemic volunteers infused at a constant rate over 30 minutes.

The maximum plasma volume expansion was reached 20 minutes after administration, with a percentage increase of 15.8. After 5 hours, the percent of plasma volume expansion was still considerable, at 9.5, with a total recruitment of fluid from tissues of 3.4 ml of fluid per ml of infused albumin, which corresponded to approximately 20% of intracellular volume.

In addition, urinary excretion was correlated with the amount of recruited extravascular fluid, but inversely correlated with residual plasma volume expansion at 5 hours.

Plasma and urine creatinine levels decreased over this period of time, and no significant changes in arterial pressure or heart rate were observed.

These findings indicate that hyperoncotic albumin is able to increase plasma volume through recruitment of interstitial fluid with about half of this expansion remaining after 4 hours of reaching its peak.