Albumin

Albumin is a protein derived from fractionating human plasma. Because albumin infusion is expensive and may be associated with adverse events, it should be used for acute volume expansion and not as a supplemental source of protein calories. Historically, albumin was used indiscriminately in the intensive care unit until anecdotal publications suggested that albumin may cause immunosuppression. However, the recently completed Saline Versus Albumin Fluid Evaluation (SAFE) trial randomized nearly 7,000 hypovolemic patients to either albumin or normal saline therapy and found that the mortality for those who received albumin was the same as for those who received normal saline.7 A subsequent post hoc analysis reported that patients with traumatic brain injury had higher mortality rates when given albumin for fluid resuscitation. These conflicting findings highlight the controversy and confusion surrounding the use of human albumin versus normal saline therapy for resuscitation of e_io critically ill patients. Albumin combined with furosemide has been demonstrated to improve fluid balance, oxygenation, and hemodynamics in the subset of patients with acute lung injury who have low serum protein. 1

Recent events have resulted in an albumin shortage in the United States with ongoing allocation of all albumin products. In brief, albumin is obtained as a by-product of routine intravenous immunoglobulin (IVIG) processing. As a result, the albumin supply is driven by the amount of plasma fractioning for IVIG. Increased efficiency of the IVIG collection techniques and decreased IVIG consumption has led to an unintended shortage of albumin available for use. Based upon this limited availability, health systems and hospitals have had to define the appropriate albumin indications for their patients and ration albumin accordingly. Evidence-based indications for albumin include plasmaphoresis/apharesis, large volume paracentesis (greater than 4 liters removed), hypotension in hemodialysis, and the need for aggressive diuresis in hypoalbuminemic hypotensive patients. Inappropriate uses of albumin include nutritional supplementation, impending hepatorenal syndrome, pancreatitis, alteration of drug pharmacokinetics, or acute normovolemic hemodilution in surgery. Practitioners can keep up with medication shortages by checking the American Society of Health-System Pharmacists (ASHP) website (www.ashp.org).

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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