Browse by author
Lookup NU author(s): Dr Gill NormanORCiD
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
© The Intensive Care Society 2024. Background: Intravenous fluid therapy is a ubiquitous intervention for the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin is presented in low volumes, is an effective resuscitation fluid and may have effects beyond plasma volume expansion alone. This systematic review aimed to assess the efficacy, safety and effectiveness of hyperoncotic albumin solutions in the management of sepsis. Methods: We searched four databases and two trial registries for controlled clinical trials of hyperoncotic albumin for management of sepsis. Review outcomes were mortality, need for renal replacement therapy, cumulative-fluid balance, and need for organ support. We used methods guided by the Cochrane Handbook for reviews of clinical interventions. Studies were assessed using Cochrane’s Risk of Bias 2 tool. We performed pairwise meta-analysis where possible. Certainty of evidence was assessed using GRADE. Results: We included six trials; four (2772 patients) were meta-analysed. Most studies had moderate or high risk of bias. There was no significant difference in 28-day mortality for septic patients receiving hyperoncotic albumin compared to other intravenous fluids (OR 0.95, [95% CI: 0.8–1.12]); in patients with septic shock (2013 patients) there was a significant reduction (OR 0.82 [95% CI: 0.68–0.98]). There was no significant difference in safety outcomes. Hyperoncotic albumin was associated with variable reduction in early cumulative fluid balance and faster resolution of shock. Conclusions: There is no good-quality evidence to support the use of hyperoncotic albumin in patients with sepsis, but it may reduce short-term mortality in the sub-groups with septic shock. It appears safe in terms of need for renal replacement therapy and is associated with reduced early cumulative fluid balance and faster resolution of shock. Larger, better quality randomised controlled trials in patients with septic shock may enhance the certainty of these findings. Review registration: PROSPERO ref: CRD42021150674.
Author(s): Bannard-Smith J, Elrakhawy M, Norman G, Owen R, Felton T, Dark P
Publication type: Article
Publication status: Published
Journal: Journal of the Intensive Care Society
Year: 2024
Pages: ePub ahead of Print
Online publication date: 19/06/2024
Acceptance date: 02/04/2018
ISSN (print): 1751-1437
ISSN (electronic): 2057-360X
Publisher: SAGE Publications Inc.
URL: https://doi.org/10.1177/17511437241259437
DOI: 10.1177/17511437241259437
Altmetrics provided by Altmetric
