?? Paper of the day
Prashant Nasa
ICU Physician - Co-editor: Rational use of IV Fluids in Critically ill (link in bio)- PROVE Network - Delphi Methodology - Fluid and Oxygen are Drugs - X: @drnasap
Use of Intravenous Albumin: A Guideline from the International Collaboration for Transfusion Medicine Guidelines.
Published in Chest
Summary
This article is a pre-print of a forthcoming guideline on the use of intravenous albumin from the International Collaboration for Transfusion Medicine Guidelines. It provides recommendations and evidence-based guidelines for the use of albumin in various clinical settings, including critical care, cardiovascular surgery, kidney replacement therapy, and complications of cirrhosis.
?? takeaways:
1. The article presents 14 recommendations on the use of albumin in different patient populations and clinical scenarios.
2. The guidelines offer conditional recommendations based on the certainty of evidence of effect in each clinical setting.
3. The article highlights the limited evidence supporting the routine use of albumin in clinical practice to improve patient outcomes.
Counter arguments:
1. The article acknowledges the challenges in establishing strong evidence for the routine use of albumin in specific patient populations and clinical scenarios.
M.D, Anesthesiologist
1 个月Good stuff. Hypotension: In a series of cases involving cardiac surgery patients, a significant drop in blood pressure (specifically, a decrease in systolic BP of 15 to 20 mmHg) was observed?following a rapid infusion of 4% albumin in a subset of patients. The?pre-kallikrein activator?found in albumin preparations stimulates the production of bradykinin, a known vasodilator. Under normal circumstances, bradykinin is inactivated in the lungs by angiotensin-converting enzyme (ACE). However, patients who are on ACE inhibitors may be more susceptible to clinically significant hypotension when receiving a rapid infusion of IV albumin. ? Paradoxical hypotension associated with rapid infusion of 4% albumin may be present in the wider intensive care population. Administration information from UpToDate recommends an infusion rate of 1 mL - 2 mL/minute. If a patient becomes more hypotensive during Albumin administration, review the medication list and look for recent ACE-I administration.?