Table 1.
Randomized clinical trials of hyperoncotic albumin in surgery and trauma
| Trial | n | Indication | Regimen | Results |
| Cardiac surgery | ||||
| Boldt et al., 1986 [37] | 55 | Coronary artery bypass grafting | 300 ml 20% albumin intraoperatively after bypass vs 500 ml 3% HES 200/0.5 vs 500 ml 3.5% gelatin vs no additional volume | Post-bypass COP rebound greater in albumin than other groups (p < 0.05) |
| Boldt et al., 1993 [41] | 30 | Cardiac defect repair in children < 3 years old | 20% albumin vs 6% HES 200/0.5 to stabilize hemodynamics before bypass | On-bypass urine output in HES group lower by 57% than that of albumin group (p < 0.05) |
| Magder and Lagonidis, 1999 [52] | 28 | Stable patients after cardiac bypass surgery | 100 ml 25% albumin vs saline to increase right atrial pressure by 2 mm Hg | Greater increase in cardiac output among hyperoncotic albumin recipients, suggesting an inotropic effect |
| Non-cardiac surgery | ||||
| Zetterström and Hedstrand, 1981 [36] | 30 | Elective major abdominal surgery | 300–400 ml 20% albumin on operation day, 200 ml on next day and 100 ml/day for subsequent 3 days vs no albumin | In albumin recipients COP significantly closer to preoperative level on postoperative days 2–6 |
| Prien et al., 1990 [39] | 18 | Abdominal surgery | 20% albumin vs 10% HES 200/0.5 vs Ringer's lactate to maintain preoperative CVP | Significantly lower intraoperative intestinal edema after albumin compared with either HES or Ringer's lactate; impaired coagulation in HES recipients |
| Trauma | ||||
| Boldt et al., 1995 [44] | 30 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | No between-group differences in daily profiles of plasma thrombomodulin, proteins C and S and thrombin-antithrombin III |
| Boldt et al., 1996 [45] | 30 | Trauma of ISS between 15 and 30 | 20% albumin vs 10% HES 200/0.5 to 12–18 mm Hg target PCWP | HES 200/0.5 but not albumin increased cardiac index, PaO2/FiO2, DO2I and VO2I (p < 0.05 for all comparisons) |
| Boldt et al., 1996 [46] | 28 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both | Maximum platelet aggregation declined in both groups (p < 0.05) |
| Boldt et al., 1996 [48] | 28 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 10–15 mm Hg target PCWP | Vasopressin decreased in HES 200/0.5 but not albumin group (p < 0.05) |
| Boldt et al., 1998 [49] | 150 | Trauma of ISS > 15 | 20% albumin vs 10% HES 200/0.5 to 12–15 mm Hg target PCWP | PaO2/FiO2 increased by HES 200/0.5 but not albumin (p < 0.05); higher cardiac index, DO2I and VO2I in HES 200/0.5 group (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT |
aPTT, activated partial thromboplastin time; COP, colloid oncotic pressure; CVP, central venous pressure; DO2I, oxygen delivery index; HES, hydroxyethyl starch; ISS, injury severity score; PaO2/FiO2, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; VO2I, oxygen consumption index.