Consider validity, clinical relevance, and applicability of albumin for critically ill patients

Editor—Because of a series of questions I have received about the current clinical use of human albumin in critically ill patients, I wish to clarify the message that I intended my editorial last week to convey.¹

Given the current evidence as summarised by the Cochrane albumin reviewers group,² the use of albumin does not need be stopped totally and immediately yet. The use of albumin in clinical practice has changed since the trials that were included in the systematic review. In the past few years the quality of albumin solutions has improved; contaminations and clinically relevant side effects are further limited. Although there is currently no evidence from clinical studies to support this, albumin given for the right indications at the right dose and infusion rate, with an optimal product being used, may be safe and effective and could lead to better outcomes than were found by the albumin reviewers group. Yet this still has to be shown. In situations where there are alternatives for albumin, such as crystalloids, and it is uncertain whether human albumin is the optimal treatment, comparative clinical studies should be undertaken to provide the evidence base for future decisions.

My use of the word “halted” in the final sentence of my editorial—“the administration of albumin should be halted until ... the results of a high quality large clinical trial are available”—was intended to mean that clinicians should pause and consider the issues of validity, clinical relevance, and applicability as presented in the editorial before giving albumin to the next critically ill patient.¹