Letters

Human albumin administration in critically ill patients

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7162.882 (Published 26 September 1998) Cite this as: BMJ 1998;317:882

Evidence needs to be shown in paediatrics

  1. Andy Petros, Consultant paediatric intensivist,
  2. Margrid Schindler, Consultant paediatric intensivist,
  3. Christine Pierce, Consultant paediatric intensivist,
  4. Steven Jacobe, Locum consultant paediatric intensivist,
  5. Quen Mok, Consultant paediatric intensivist
  1. Intensive Care Units, Great Ormond Street Hospital for Sick Children NHS Trust, London WC1N 3JH
  2. Hammersmith Hospital, London W12 0HS
  3. St Mary's Hospital, London W2 1NY
  4. Netherlands Cancer Institute, NL-1066 CX Amsterdam, Netherlands
  5. Undergraduate Teaching Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS
  6. Birmingham Children's Hospital, Birmingham B4 6NH
  7. Leighton Hospital, Crewe, Cheshire CW1 4QJ
  8. Chelsea and Westminster Hospital, London SW10 9NH
  9. Southmead Hospital, Bristol BS10 5NB
  10. Directorate of Intensive Care and Respiratory Medicine, Guy's and St Thomas's Hospital Trust, Guy's Hospital, London SE1 9RT
  11. St Andrew's Centre for Burns, Chelmsford, Essex CM1 7ET
  12. Director UK Cochrane Centre, NHS Research and Development Programme, Oxford OX2 7LG
  13. Intensive Care Society, London WC1H 9HR
  14. Royal Albert Edward Infirmary, Wigan WN1 2NN
  15. Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH

    Editorial by McClelland

    EDITOR—We are concerned that the Cochrane Injuries Group's meta-analysis regarding administration of albumin1 may alter the practice of resuscitating hypovolaemic hypotensive children, infants, and neonates. Although we are affiliated to the Institute of Child Health, we want to emphasise that this article does not reflect our own clinical practice, and at present we believe that it 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 there are 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 gain (Kanarek et al). In a third study (n=27) that assessed the use of bicarbonate in acidotic neonates only the control groups of 5% dextrose and albumin were compared (Bland et al).

    We are now faced with concerns from parents about the “killer fluid,” and our junior staff are confused about the appropriate fluid to use for resuscitation of critically ill children. Have we been put into a legally indefensible position by this report from the Cochrane Injuries Group?

    We continue to use albumin for several reasons. To produce the same sustained increase in blood pressure as a 20 ml/kg bolus of albumin, up to five times as much volume of crystalloid would have to be given based on their relative oncotic pressures.2 This increased volume of crystalloid may lead to problems with fluid overload, hyperchloraemia in renal dysfunction, and pulmonary oedema. One leading …

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