Fluid administration is one of the most common items managed every day in hospitalized and intensive care unit (ICU) patients. The optimal fluid for sepsis resuscitation remains unknown, with concerns about both crystalloids and colloids.
Caironi and colleagues sought to examine whether albumin supplementation would benefit patients with severe sepsis and septic shock. This study randomly assigned 1818 of these patients within 24 hours of ICU admission to receive either crystalloids or crystalloids plus albumin supplementation, to maintain a serum albumin level of 3 g/dL.
Early in the course, albumin-treated patients had at least intermittently higher central venous pressure, higher mean arterial pressure, and less positive fluid balance. There was no difference in mortality at 28 days or 90 days, although the subset of patients with septic shock treated with albumin did have a lower mortality at 90 days (43.6% vs 49.9%; P = .03).
A growing body of literature suggests that hydroxyethyl starch solutions may cause renal damage, particularly in patients with sepsis.[2-5] Conversely, albumin has been suggested to confer benefit in sepsis resuscitation.[6,7]
In this study, albumin supplementation to maintain normal circulating serum albumin levels was not shown to be superior overall to crystalloid administration alone. This was true for starting the intervention earlier or later (< 6 hours vs 6-24 hours), and for outcomes measured earlier or later. But the subset of patients with septic shock did have statistically greater survival at 90 days, which raises the question of albumin superiority for this subgroup, and perhaps even as a later effect not related to the early resuscitation.
Unfortunately, for general patient care, this study does not provide a definite answer. And the major question of whether different uses of albumin, such as in the earliest phases of fluid resuscitation and targeted to goals other than maintaining circulating level, still needs to be studied.