Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy.
Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology-Tyrol, 6060 Hall in Tyrol, Austria.
Int J Mol Sci. 2022 Nov 16;23(22):14175. doi: 10.3390/ijms232214175.
Intravenous administration of crystalloid or colloid solutions is the most common intervention for correcting hypovolemia in intensive care unit patients. In critical illness, especially sepsis and severe trauma, vascular wall permeability increases, and trans-endothelial escape of serum albumin, the major oncotic plasma constituent, contributes to the development of hypoalbuminemia and edema formation. The volume effects of intravenous human albumin solution exceed those of crystalloid solutions. If hypoalbuminemia is an effect moderator, the crystalloid-to-albumin ratio of fluid resuscitation volumes is not well characterized. Randomized controlled trials have confirmed that intravenous administration of human albumin solutions for volume resuscitation results in a lower net fluid balance compared with crystalloids, and smaller infusion volumes may be sufficient for hemodynamic stabilization when human albumin solutions are used. This narrative review summarizes the current evidence and conclusions drawn regarding the role of hypoalbuminemia in volume resuscitation. In the 'Saline versus Albumin Fluid Evaluation' study using 4% human albumin solution or saline, the saline-to-albumin ratio of study fluids was significantly higher in patients with baseline serum albumin concentrations of 25 g/L or less as compared to patients with baseline serum albumin concentrations of more than 25 g/L. In patients receiving renal replacement therapy, intravenous administration of 20-25% human albumin solution reduces intradialytic hypotension and improves fluid removal better than saline if serum albumin levels are similarly reduced. These data suggest that hypoalbuminemia acts as an effect moderator in volume resuscitation and plasma expansion with albumin solution. The volume effectiveness of intravenous human albumin solution in resuscitation appears to be greater when the serum albumin levels are low. In clinical situations, serum albumin concentrations per se may inform when and how to include intravenous albumin in fluid resuscitation if large amounts of crystalloids are needed, which requires further studies.
静脉输注晶体液或胶体液是纠正重症监护病房患者低血容量的最常见干预措施。在危重病中，特别是脓毒症和严重创伤，血管壁通透性增加，血清白蛋白（主要的胶体血浆成分）经内皮细胞逃逸，导致低白蛋白血症和水肿形成。静脉用人白蛋白溶液的容量效应超过晶体液。如果低白蛋白血症是一种效应调节剂，那么液体复苏中晶体液与白蛋白的比例尚不清楚。随机对照试验已经证实，与晶体液相比，静脉用人白蛋白溶液进行容量复苏会导致更低的净液体平衡，并且当使用人白蛋白溶液时，较小的输注量可能足以实现血流动力学稳定。本叙述性综述总结了关于低白蛋白血症在容量复苏中的作用的现有证据和结论。在使用 4%人白蛋白溶液或生理盐水的“生理盐水与白蛋白液评估”研究中，与基线血清白蛋白浓度大于 25g/L 的患者相比，基线血清白蛋白浓度为 25g/L 或更低的患者的研究液中生理盐水与白蛋白的比例明显更高。在接受肾脏替代治疗的患者中，如果血清白蛋白水平相似，与生理盐水相比，静脉输注 20-25%人白蛋白溶液可减少透析期间低血压，并更好地改善液体清除。这些数据表明，低白蛋白血症作为一种效应调节剂，在白蛋白溶液的容量复苏和血浆扩张中起作用。在复苏中，静脉用人白蛋白溶液的容量有效性似乎在血清白蛋白水平较低时更大。在临床情况下，如果需要大量晶体液，血清白蛋白浓度本身可能会提示何时以及如何将静脉白蛋白纳入液体复苏，这需要进一步的研究。
