[Albumin therapy for patients with increased intracranial pressure: oncotic therapy]

Albumin plays an important role in maintaining an adequate plasma colloid osmotic pressure (COP). On the basis of the Starling's law, we postulated that elevation of plasma COP produced by infusion of serum albumin would result in the withdrawal of cerebral interstitial fluid. To test the hypothesis that an oncotic gradient would produce cerebral dehydration and result in reduction of intracranial pressure (ICP), we infused intravenously 25% solution of salt-poor human serum albumin, 2g/kg over 60 minutes for 10 patients with increased ICP. In these 10 patients, the degree of brain edema was not severe but mild to moderate by judging from CT scan findings. In addition to ICP, various parameters such as mean arterial blood pressure (MABP), central venous pressure (CVP), pulse rate, PaCO2 and urine volume were measured before, during and after albumin infusion. Hematological studies including COP, total protein, albumin-globulin ratio, protein fractions, hematocrit (Ht), blood urea nitrogen (BUN), creatinine and electrolytes were also performed before, during and after administration of albumin. The raised ICP (27.4 +/- S.E. 1.6 mmHg) decreased significantly down to 19.1 (+/- 1.9) mmHg and remained stable for at least 240 minutes without any changes of MABP, pulse rate and PaCO2. CVP elevated significantly and remained at higher levels in comparison with control despite increase of urine output after administration of albumin. This results suggested that an adequate circulatory volume was maintained. A significant increase of total protein, serum albumin concentrations and albumin-globulin ratio was noted.(ABSTRACT TRUNCATED AT 250 WORDS)