Albumin Replacement in Patients with Severe Sepsis or Septic Shock

For decades, human albumin has been administered to patients to provide adequate oncotic pressure and intravascular volume. In 1998, however, a report from the Cochrane Injuries Group Albumin Reviewers indicated that the administration of albumin may be potentially harmful in critically ill patients, as compared with the administration of crystalloid solutions. Subsequent meta-analyses reported contradictory findings.

To clarify this issue, a large, double-blind, randomized trial (the Saline versus Albumin Fluid Evaluation [SAFE] study) was conducted, in which 4% albumin solution was compared with normal saline as fluid replacement in critically ill patients, with results indicating that albumin administration was safe. A predefined subgroup analysis showed that patients with severe sepsis receiving albumin were at a lower, although not significantly lower, risk for death than those receiving normal saline. In addition, a subsequent study pointed out a potential benefit of maintaining serum albumin at a level of more than 30 g per liter in critically ill patients.

There is a convincing rationale for the potential advantages of albumin administration during severe sepsis. Albumin is the main protein responsible for plasma colloid osmotic pressure; it acts as a carrier for several endogenous and exogenous compounds, with antioxidant and antiinflammatory properties, and as a scavenger of reactive oxygen and nitrogen species and operates as a buffer molecule for acid–base equilibrium. We therefore conducted a randomized, controlled trial to investigate the effects of the administration of albumin and crystalloids, as compared with crystalloids alone, targeting a serum albumin level of 30 g per liter or more in a population of patients with severe sepsis…