Critical illness: albumin infusions to maintain colloid osmotic pressure did not clearly benefit post-operative critically ill patients.

Clinical bottom line (level 1b-)

  1. A strategy of albumin infusions for maintenance of colloid osmotic pressure did not clearly preserve renal function, or prevent death in critically ill patients.
Grundmann and Heistermann: Archives of Surgery 1985; 120: 911-915
Expires July 2003

The study

Unblinded concealed randomised trial with intention-to-treat
Setting: intensive care unit of university hospital, Germany

220 patients (aged range 3 to 90 years; mean 55, 60% male) critically ill postoperative patients

Excluded if
  • in ICU for <2 days


    • Note:
  • Causes of critical illness were multiple trauma in 17%, vascular surgery in 37% and major abdominal surgery in 45%.


    • Control Group: (n = 106, 106 analysed): albumin infusions to maintain colloid osmotic pressure > or = 24 cm H 2 O (mean 52 g albumin)
    Experimental Group: (n = 114, 114 analysed): albumin infusions to maintain colloid osmotic pressure > or = 29 cm H 2 O (mean 96 g albumin)

    100% followed for 2 days

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    ventilatory support days 57
    (53.8%)    		 64
    (56.1%)    		 -4%
    (-33% to 18%)    		 -2.37%
    (-15.5% to 10.8%)    		 -42
    (NNT = 9 to infinity;
    NNH = 6 to infinity)
    raised creatinine days 25
    (23.6%)    		 30
    (26.3%)    		 -12%
    (-77% to 30%)    		 -2.73%
    (-14.2% to 8.70%)    		 -37
    (NNT = 11 to infinity;
    NNH = 7 to infinity)
    death days 28
    (26.4%)    		 24
    (21.1%)    		 20%
    (-28% to 51%)    		 5.36%
    (-5.88% to 16.6%)    		 19
    (NNT = 6 to infinity;
    NNH = 17 to infinity)

  • Patients were followed for more than two days.

    • Comments

    1. Note the two groups both failed to actually reach the prespecified treatment objectives (in terms of COP), which may contribute to the lack of success. However, this also indicates the difficulty of using these strategies in clinical practice.
    2. The study is too small to show any clinically important differences between the groups in outcome. A recent large systematic review has shown that critically ill patients given albumin are more likely to die than those given saline.

    Citation

    1. Grundmann R, and Heistermann S: Postoperative albumin infusion therapy based on colloid osmotic pressure. A prospectively randomized trial.. Archives of Surgery 1985; 120: 911-915
    Search Terms: author's files
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Luis Ruiz del Fresno

    Clinical Question.
    Patient critically ill post-operative patients
    Intervention or Exposure albumin infusions to maintain colloid osmotic pressure
    Outcome mortality