In My Opinion: Serum Albumin Should be Maintained During Neurocritical Care
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REVIEW
In My Opinion: Serum Albumin Should be Maintained During Neurocritical Care David J. Powner
Published online: 23 February 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Hypoalbuminemia is common among critically ill/injured patients and is strongly associated with increased morbidity and mortality in the patients with and without neurological conditions. Normal serum albumin is important as the primary intravascular antioxidant, in transporting a variety of hormones, medications and electrolytes, in providing colloid osmotic pressure during trans-compartmental fluid movement, in enhancing organ and tissue blood flow, and in supporting acid–base balance. Studies of albumin administration during intravascular resuscitation have not addressed potential longer term benefits to sustaining serum albumin concentrations during critical care. Evidence for such benefit is present although additional prospective studies are needed. Keywords Serum albumin Brain injuries Brain infarction Cerebrovascular accident
Introduction Hypoalbuminemia is common after traumatic brain injury (TBI) and other neurosurgical and neurological conditions. Although genetic variations may produce hypoalbuminemia and altered albumin structure [1, 2], most patients develop low serum albumin due to one or more of the D. J. Powner (&) Departments of Neurosurgery and Internal Medicine, University of Texas Health Sciences Center at Houston Medical School, 6431 Fannin Street, MSB 7.154, Houston, TX 77030, USA e-mail: [email protected] D. J. Powner Vivian L. Smith Center for Neurological Research, Houston, TX, USA
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causes shown in Table 1 [3–6]. The normal half-life of albumin is 18–20 days, but the rapidity with which hypoalbuminemia develops in critical illness or injury attests to the efficiency of the cited etiologic mechanisms [2, 7]. The Saline versus Albumin Fluid Evaluation (SAFE) study [8] of general intensive care unit (ICU) patients and a meta-analysis of volume resuscitation with hyper-oncotic albumin [9] found no harm but also no advantage for albumin over saline. In addition, a subsequent post-hoc subgroup analysis of TBI patients [10] within the SAFE group identified a mortality disadvantage for resuscitation with albumin after TBI. Additional subgroup analysis of 1218 patients with severe sepsis within the original SAFE study population of 6997 patients has recently been published [11]. It found a statistically significant (P < 0.003) adjusted odds ratio for death at 0.71 when albumin versus saline had been used during resuscitation. The SAFE study evaluated albumin administration directed to hemodynamic endpoints, not the possible benefits of maintaining serum albumin during ongoing care. My intention is to review normal physiological functions of albumin, the association and perhaps causal relationship between hypoalbuminemia and morbidity/mortality in general and neurological patients and data that indicate benefit to maintaining normal serum albumin. Publications were selected from my files and fr
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