{Reference Type}: Journal Article
{Title}: Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial.
{Author}: Wigmore GJ;Deane AM;Presneill JJ;Eastwood G;Serpa Neto A;Maiden MJ;Bihari S;Baker RA;Bennetts JS;Ghanpur R;Anstey JR;Raman J;Bellomo R; ;
{Journal}: Intensive Care Med
{Volume}: 50
{Issue}: 7
{Year}: 2024 Jul 2
{Factor}: 41.787
{DOI}: 10.1007/s00134-024-07488-3
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.