Human albumin administration in critically ill patients

BMJ 1998;317:882 ( 26 September )

Letters

Human albumin administration in critically ill patients

Evidence needs to be shown in paediatrics

Critical analysis of original studies has to take place

Review did not provide recommendations for alternative treatment

More research into proper use of albumin is needed

Albumin has been used in meningococcal disease

Validity of review methods must be assessed

Paper failed to mention earlier review

Analysis is superficial and conclusions exaggerated

Statisticians not trained in burns care should not evaluate data

I would not want an albumin transfusion

Modified editorial might have restrained media response

Some patients may benefit

Authors' response

Evidence needs to be shown in paediatrics

Editorial by McClelland

The first 150 words of the full text of this article appear below.

EDITOR $---$ We are concerned that the Cochrane Injuries Group's meta-analysis regarding administration of albumin¹ may alterthe practice of resuscitating hypovolaemic hypotensive children, infants, and neonates. Although we are affiliated to the Instituteof Child Health, we want to emphasise that this article does notreflect our own clinical practice, and at present we believe thatit provides no compelling evidence to change our practice.

We reviewed the 32 articles in the three groups. We identified only one paediatric study (So et al) in the hypovolaemia group,in which 63 preterm infants received albumin for hypotension.In the burns group there is only one paediatric study (n=70),in which albumin was given to maintain arbitrary serum concentrations(Greenhalgh et al). Finally, in the hypoproteinaemic group thereare two studies of 64 neonates that addressed several hypotheses,including whether albumin was detrimental to respiratory status(Greenough et al) and was beneficial in weight . . . [Full text of this article]

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