Reappraising the role of albumin for resuscitation

Fluid resuscitation is a common intervention in acute medical practice. The optimum fluid for resuscitation remains hotly debated and it is likely to vary from one clinical situation to another. Human albumin solutions have been available since the 1940s, but their use varies greatly around the world. This review examines the current evidence for and against the use of albumin as a resuscitation fluid.

Fluid resuscitation with albumin has been compared to resuscitation with saline in large high-quality trials in adult ICU patients and in African children. Within overall equivalent effects, albumin may offer a slight mortality benefit in adult ICU patients with severe sepsis whilst increasing mortality in patients with traumatic brain injury. There are no recent high-quality trials comparing albumin to synthetic colloid solutions. In African children with febrile illness and compensated shock, the effects of bolus resuscitation with albumin and saline are similar, but both increase mortality compared to treatment that avoids fluid boluses.

Fluid resuscitation with albumin is well tolerated and produces similar results to resuscitation with saline. Albumin should be avoided in patients with traumatic brain injury; possible benefits in adults with severe sepsis remain to be confirmed.