Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/35433
Title: Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial.
Austin Authors: Wigmore, Geoffrey J;Deane, Adam M;Presneill, Jeffrey J;Eastwood, Glenn M ;Serpa Neto, Ary ;Maiden, Matthew J;Bihari, Shailesh;Baker, Robert A;Bennetts, Jayme S;Ghanpur, Rashmi;Anstey, James R;Raman, Jaishankar;Bellomo, Rinaldo 
Affiliation: Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.;Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, VIC, Australia.
Intensive Care
Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Intensive Care Unit, Barwon Health, Geelong, VIC, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.;Department of ICCU, Flinders Medical Centre, Adelaide, SA, Australia.
Flinders Medical Centre and College of Medicine and Public Health Flinders University, Cardiothoracic Quality and Outcomes, Adelaide, SA, Australia.
Department of Intensive Care, Warringal Private Hospital, Melbourne, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.;Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.;Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, VIC, Australia.
Issue Date: Jul-2024
Date: 2024
Publication information: Intensive Care Medicine 2024-07; 50(7)
Abstract: After cardiac surgery, fluid bolus therapy (FBT) with 20% human albumin may facilitate less fluid and vasopressor administration than FBT with crystalloids. We aimed to determine whether, after cardiac surgery, FBT with 20% albumin reduces the duration of vasopressor therapy compared with crystalloid FBT. We conducted a multicentre, parallel-group, open-label, randomised clinical trial in six intensive care units (ICUs) involving cardiac surgery patients deemed to require FBT. We randomised 240 patients to receive up to 400 mL of 20% albumin/day as FBT, followed by 4% albumin for any subsequent FBT on that day, or to crystalloid FBT for at least the first 1000 mL, with use of crystalloid or 4% albumin FBT thereafter. The primary outcome was the cumulative duration of vasopressor therapy. Secondary outcomes included fluid balance. Of 480 randomised patients, 466 provided consent and contributed to the primary outcome (mean age 65 years; median EuroSCORE II 1.4). The cumulative median duration of vasopressor therapy was 7 (interquartile range [IQR] 0-19.6) hours with 20% albumin and 10.8 (IQR 0-22.8) hours with crystalloids (difference - 3.8 h, 95% confidence interval [CI] - 8 to 0.4; P = 0.08). Day one fluid balance was less with 20% albumin FBT (mean difference - 701 mL, 95% CI - 872 to - 530). In patients after cardiac surgery, when compared to a crystalloid-based FBT, 20% albumin FBT was associated with a reduced positive fluid balance but did not significantly reduce the duration of vasopressor therapy.
URI: https://ahro.austin.org.au/austinjspui/handle/1/35433
DOI: 10.1007/s00134-024-07488-3
ORCID: 0000-0003-0989-5640
0000-0002-7620-5577
0000-0001-7177-7667
0000-0001-7700-9933
0000-0003-1520-9387
0000-0003-4345-3213
0000-0001-7553-8620
0000-0002-1847-850X
0000-0003-2398-8501
0000-0002-8025-1218
0000-0002-7691-4779
0000-0002-1650-8939
Journal: Intensive Care Medicine
Start page: 1075
End page: 1085
PubMed URL: 38953926
ISSN: 1432-1238
Type: Journal Article
Subjects: Albumin
Cardiac surgery
Critical care
Fluid therapy
Resuscitation
Fluid Therapy/methods
Fluid Therapy/standards
Fluid Therapy/statistics & numerical data
Cardiac Surgical Procedures/methods
Vasoconstrictor Agents/administration & dosage
Vasoconstrictor Agents/therapeutic use
Crystalloid Solutions/administration & dosage
Crystalloid Solutions/therapeutic use
Albumins/administration & dosage
Albumins/therapeutic use
Intensive Care Units/statistics & numerical data
Isotonic Solutions/administration & dosage
Isotonic Solutions/therapeutic use
Appears in Collections:Journal articles

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