Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Pathology, McMaster University, Hamilton, ON, Canada.
Crit Care Med. 2018 Apr;46(4):e326-e329. doi: 10.1097/CCM.0000000000002955.
Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis.
We performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services). Two-tailed independent t tests were performed for all possible comparative analyses. Analysis of variance testing was performed for relevant three-way comparisons. Significance threshold was set at p less than 0.05.
All samples were analyzed in the core laboratory at an academic hospital associated with McMaster University in Hamilton, Ontario, Canada.
We analyzed 65 albumin samples from three available brands obtained through Canadian Blood Services. They include Plasbumin (n = 21), Alburex (n = 24), Octalbin (n = 20).
Laboratory technologists blinded to product identification measured the concentration of electrolytes, extended electrolytes, lactate, and albumin of each sample using the Abbott ARCHITECT c8000 chemistry analyzer.
The mean chloride concentration of Plasbumin, Alburex, and Octalbin, respectively, were 109.4 mmol/L (SD, 1.3), 123.6 mmol/L (SD, 1.3), and 136.8 mmol/L (SD, 0.4). The mean sodium concentration of Plasbumin, Alburex, and Octalbin, respectively, were 139.6 mmol/L (SD, 1.6), 137.3 mmol/L (SD, 2.2), and 149.4 mmol/L (SD, 0.5). The chloride and sodium concentration differed significantly for all two-way comparisons (p < 0.0001) and multiple comparison testing (p < 0.0001).
This study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining the effect of administering high chloride versus low chloride fluids in critically ill patients with sepsis.
在脓毒症患者的复苏中使用高氯 IV 液可能与死亡率增加和肾脏替代治疗的使用有关。在晶体液之后，5%人血白蛋白是 ICU 中第二常用的复苏液。其氯浓度在临床环境中很少被考虑。本研究使用生化分析量化了三种 5%白蛋白溶液以前未记录的氯浓度。
我们对直接从国家血液供应商（加拿大血液服务）获得的白蛋白样本进行了电解质浓度的盲法分析。对所有可能的比较分析均进行了双尾独立 t 检验。对于相关的三向比较进行了方差分析检验。显著性阈值设为 p 值小于 0.05。
所有样本均在位于安大略省汉密尔顿的麦克马斯特大学附属学术医院的核心实验室进行分析。
我们分析了通过加拿大血液服务获得的三种可用品牌的 65 个白蛋白样本。它们包括 Plasbumin（n = 21）、Alburex（n = 24）和 Octalbin（n = 20）。
实验室技术人员对产品标识进行了盲法，使用 Abbott ARCHITECT c8000 化学分析仪测量了每个样本的电解质、扩展电解质、乳酸和白蛋白的浓度。
Plasbumin、Alburex 和 Octalbin 的平均氯浓度分别为 109.4 mmol/L（SD，1.3）、123.6 mmol/L（SD，1.3）和 136.8 mmol/L（SD，0.4）。Plasbumin、Alburex 和 Octalbin 的平均钠浓度分别为 139.6 mmol/L（SD，1.6）、137.3 mmol/L（SD，2.2）和 149.4 mmol/L（SD，0.5）。所有两种方式的比较（p < 0.0001）和多重比较检验（p < 0.0001）均显示氯和钠浓度差异有统计学意义。
本研究首次确定并记录了现有 5%白蛋白产品中氯浓度的统计学显著变异性。本研究还为一项在脓毒症危重症患者中比较给予高氯和低氯液体的效果的随机对照试验提供了信息。
