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Hospital Pharmacy Europe     Newsletter          

Small volume resuscitation with 20% albumin in intensive care: physiological effects: The SWIPE randomised clinical trial

Resuscitation with albumin preparations presents advantages over procedures using crystalloid solutions, namely preservation of the plasma’s oncotic pressure and attenuation of fluid accumulation.

However, the expected volume-expanding effect for 20% albumin is almost twice the infused volume, and a smaller volume of this solution may be needed to achieve a haemodynamic response similar to the one obtained with 4–5% albumin.

To further investigate the effects of 20% albumin on volume requirements, fluid balance, and physiological and biochemical responses, a pilot study evaluated 321 patients who received 20% and 4–5% albumin preparations during the first 48 hours upon admission to an intensive care unit.

The volume of resuscitation fluid at 48 hours was lower in patients in the 20% albumin arm (mean difference of 576ml), who presented increased albumin levels with an equivalent urinary output.

Consequently, the fluid balance was lower for the hyperoncotic albumin solution, but the haemodynamic parameters were similar.

Duration of mechanical ventilation and need for renal replacement therapy did not differ between the groups.

In terms of safety, survival and mortality rates were not affected by albumin concentration.

These data show that small-volume resuscitation with 20% albumin is an effective and safe option in intensive care.