Indications and role of albumin for vascular loading during postoperative intensive care

Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). Only one trial referred to hyperoncotic albumin and therefore did not allow to produce recommendations. However, a priori hyperoncotic albumin should not be used for plasma volume expansion. All other studies compared isooncotic albumin to crystalloid or hydroxyethylstarches (HES). It is concluded that albumin can be recommended neither after vascular (aortic abdominal surgery), nor abdominal surgery and can be replaced by Ringer lactate solution in a volume 1.5 to 2 times higher than with albumin. After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.