背景:白蛋白通常在广泛的临床环境中使用,以改善血液动力学,便于流体去除,并管理肝硬化的并发症。国际输血医学合作指南制定了需要重症监护的患者使用白蛋白的指南,接受心血管手术,肾脏替代疗法,或经历肝硬化的并发症。
方法:共同主席监督指南制定过程,小组包括研究人员,临床医生,方法学家,和患者代表。本指南的证据来自对随机临床试验和系统评价的系统评价,在其中搜索了多个数据库(开始至2022年11月23日)。小组审查了数据,并使用建议评估的分级制定了指南建议,开发和评估(等级)方法。该指南在公众咨询后进行了修订。
结果:小组就成人重症监护中的白蛋白使用提出了14项建议(3项建议),儿科重症监护(1条建议),新生儿重症监护(2条建议),心血管手术(2个建议),肾脏替代疗法(1个推荐),和肝硬化的并发症(5个建议)。在14项建议中,2有适度的证据确定性,5的证据确定性低,7的证据确定性很低。14项建议中有2项建议对接受大体积穿刺或自发性细菌性腹膜炎的肝硬化患者有条件地使用白蛋白。14项建议中有12项没有建议在通常输注白蛋白的各种临床情况下使用白蛋白。
结论:目前很少有基于证据的适应症支持在临床实践中常规使用白蛋白来改善患者预后。本指南为临床医生提供有关白蛋白使用的可行建议。
BACKGROUND: Albumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine
Guidelines developed
guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis.
METHODS: Cochairs oversaw the
guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this
guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the
guideline recommendations using Grading of Recommendations Assessment, Development, and Evaluation methodology. The
guidelines were revised after public consultation.
RESULTS: The panel made 14 recommendations on albumin use in adult critical care (three recommendations), pediatric critical care (one recommendation), neonatal critical care (two recommendations), cardiovascular surgery (two recommendations), kidney replacement therapy (one recommendation), and complications of cirrhosis (five recommendations). Of the 14 recommendations, two recommendations had moderate certainty of evidence, five recommendations had low certainty of evidence, and seven recommendations had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin commonly is transfused.
CONCLUSIONS: Currently, few evidence-based indications support the routine use of albumin in clinical practice to improve patient outcomes. These guidelines provide clinicians with actionable recommendations on the use of albumin.