The role and place of albumin in modern infusion-transfusion therapy

V.I. Cherniy

Abstract


Infusion-tranfusion therapy (ITT) has been one of the main instruments of the influence on homeostasis in critical conditions of different nature. Currently, ITT is an essential component of anesthetic and intensive care. However, improper restoration of fluid balance was a major cause of mortality in intensive care units and post-operative intensive care in the 1980s. The prescription of any infusion media is an intervention into the internal environment of the body that affects in a greater or lesser degree the performance of water-salt metabolism, acid-base balance, osmolarity. Therefore, the clinician is advisable to take into account the basic concepts of water-electrolyte metabolism, and their changes under the influence of ITT, information about the function and dysfunction of the vascular endothelium, the properties of different intravenous fluids and hemodynamic monitoring capabilities to evaluate the adequacy of ITT. Great importance for water retention and displacement has a so-called colloid osmotic pressure (COP) of the plasma, or oncotic pressure produced by plasma proteins. According to some researchers, the COP is the main factor determining the movement of water between the tissues and capillaries. When prescribing volume correcting infusion, the value of COP should be considered. Study was conducted to find changes in COP of the plasma in connection with surgery and ongoing ITT. The surgery itself causes extravasation of fluid, intravenous fluid and significantly increases this movement. Crystalloid infusion during abdominal surgery resulted in a decrease in cardiac output in half of patients. It is believed that the creation of intravascular normovolemia during surgery is optimal to protect the endothelial glycocalyx (EG), to decrease inflammatory mediators in pathological changes, to minimize transcapillary fluid exchange by maintaining EG proteins. Restrictive regime of intravenous fluid administration significantly reduces the risk of postoperative complications. In surgical patients at high risk, the targeted controlled infusion therapy is suitable. It should be noted that among the colloidal preparations, natural colloid albumin has no alternative in terms of multifunctional action. The use of 20% albumin is effective, but requires a differentiated approach to the treatment and further large-scale studies with high reliability in terms of evidence-based medicine.


Keywords


vascular endothelium; albumin; colloids; infusion-transfusion therapy; review

References


Strunden M.S, Heckel K., Goetz A.E, Reuter D.A. Perioperative fluid and volume management: physiological basis, tools and strategies // Ann. Intensive Care. — 2011. — 1. — 2. Published online 2011 Mar 21. doi: 10.1186/2110-5820-1-2.

Rangunathan K. et al. Choice of fluid in acute illness: what should be given? An international consensus // BJA. — 2014. — Vol. 113, № 5. — P. 772-783.

Ertmer C., Van Aken H. Fluid therapy in patients with brain injury: what does physiology tell us? // Critical Care. — 2014. — V. 18. — P. 119

Joshi G.P. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery // Anesth. Analg. — 2005. — Vol. 101, № 2. — P. 601-605.

Payen D. Back to basic physiological questions and consideration of fluids as drugs // BJA. — 2014. — V. 113, № 50. — Р. 732-733.

Pinsky M.R. Clinical trials without concept foundation may produce flawed results for the management of fluid therapy in the critically ill // BJA. — 2014. — V. 113, № 5. — Р. 737-739.

Черний В.И., Колесников А.Н., Олейников К.Н., Егоров А.А., Белошапка В.А. Рациональная инфузионная терапия. — Донецк: Издатель Заславский А.Ю., 2012. — 182 с.

Wright B.D., Hopkins A. Changes in colloid osmotic pressure as a function of anesthesia and surgery in the presence and absence of isotonic fluid administration in dogs // Vet. Anaesth. Analg. — 2008. — Vol. 35, № 4. — P. 282-288.

Ильинский А.А., Молчанов И.В., Петрова М.В. Интраоперационная инфузионная терапия в периоперационном периоде // Вестник РНЦРР МЗ РФ. — 2012. — № 12. — С. 65-73.

Максименко А.В., Турашев А.Д. Эндотелиальный гликокаликс системы кровообращения. I. Обнаружение, компоненты, структурная организация // Биоорганическая химия. — 2014. — Т. 40, № 2. — С. 131-141.

Schött U. The endothelial glycocalyx and its disruption, protection and regeneration: a narrative review / Schött U., Solomon C., Fries D., Bentzer P. // Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. — 2016. — V. 24. — Р. 24-48.

Dvorak H.F. Vascular permeability to plasma, plasma proteins, and cells: an update // Curr. Opin. Hematol. — 2010. — Vol. 17, № 3. — P. 225-229.

Weinbaum S., Tarbell J.M., Damiano E.R. The structure and function of the endothelial glycocalyx layer // Annu Rev. Biomed. Eng. — 2007. — № 9. — P. 121-167.

Дементьева И.И. Лабораторная диагностика и клиническая оценка нарушений гомеостаза у больных в критическом состоянии. — М.: РНЦХ РАМН, 2007. — 161 с.

Jacob M., Bruegger D., Rehm M. et al. The endothelial glycocalyx affords compatibility of Starling’s principle and high cardiac interstitial albumin levels // Cardiovasc. Res. — 2007. — Vol. 73, № 3. — Р. 575-586.

Chappell D., Jacob М., Hofmann-Kiefer К. et al. A Rational Approach to Perioperative Fluid Management // Anesthe­siology. — 2008. — Vol. 109, № 4. — P. 723-740.

An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. The REN AL Replacement Therapy Study Investigators // Critical Care Medicine. — 2012. — Vol. 40, № 6. — P. 1753-1760.

Guideline for the use of human albumin solution (HAS) / Dr. Paul Holmes, dr. Toby Garrood. — London, 2015.

Пашина Е.В., Золотавина М.Л. Альбумин в оценке эндогенной интоксикации // Наука и современность. — 2014. — № 33. — С. 23-28.

Marx G. Fluid therapy in sepsis with capillary lea­kage // Eur. J. Anaesthesiol. — 2003. — Vol. 20, № 6. — P. 429-442.

Matthew W. Semler, Todd W. Rice. Sepsis Resuscitation Fluid Choice and Dose // Clin. Chest. Med — 2016. http://dx.doi.org/10.1016/j.ccm.2016.01.007

Artigas A., Wernerman J., Arroyo V., Vincent J.L., Levy M. Role of albumin in diseases associated with severe systemic inflammation: Pathophysiological and clinical evidence in sepsis and in decompensated cirrhosis // Journal of Critical Care. — 2015. — doi: 10.1016/j.jcrc.2015.12.019

Vanzant E.L. et al. Persistent inflammation, immunosuppression, and catabolism syndrome after severe blunt trauma // J. Trauma Acute Care Surg. — 2014. — V. 76, № 1. — P. 21-29.

Глумчер Ф.С. Возможности применения альбумина в терапии критических состояний: современное состояние проблемы // Медицина неотложных состояний. — 2014. — 2 (57). — С. 63-73.

Георгиянц М.А., Корсунов В.А. Альбумин в инфузионной терапии критических состояний: немного «старой» теории и новых метаанализов // Біль, знеболювання і інтенсивна терапія. — 2007. — № 1. — С. 59-64.

Шлапак І.П., Нетяженко В.З., Галушко О.А. Інфузійна терапія в практиці лікаря внутрішньої медицини: навчальний посібник. — К.: Логос, 2013. — 308 с.

Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials // BMJ. — 1998. — № 7. — 255-240.

Surviving Sepsis Campaign: International Guidelines for Management of severe Sepsis and Septic Shock: 2012 / R.P. Dellinger, M.M. Levy, A. Rhodes [et al.] // Intensive care Medicine. — 2013. — Vol. 41, 32. — Р. 2-64.

Wilkes M., Navickis R., Wilkes M. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials // Ann. Intern. Med. — 2001. — V. 135. — 149-164.

Von Hoegen I., Waller C. Safety of human albumin based on spontaneously reported serious adverse events // Crit. Care Med. — 2001. — 29. — 994-996.

Haynes G.R., Naviсkis R.J., Wilkes M.M. Albumin administration — what is the evidence of clinical benefit? A syste­matical review of randomized controlled trials // Europ. J. Anesthesiology. — 2003. — 20. — 771-793.

Martenssona J., Bellomoa R. Are all fluids bad for the kidney? // Curr. Opin. Crit. Care. — 2015. — V. 21, № 4. — Р. 292-301.

Matthew D. McGuire and Michael Heung Fluid as a Drug: Balancing Resuscitation and Fluid Overload in the Intensive Care Setting // Advances in Chronic Kidney Disease. — 2016. — Vol. 23, № 3. — Р. 152-159.

Zazzerona L., Gattinonib L., Caironia P. Role of albumin, starches and gelatins versus crystalloids in volume resuscitation of critically ill patients // Curr. Opin. Crit. Care. — 2016. — V. 22, № 5. — Р. 428-436.

Жуков Е.А., Борцов Д.А., Обедин А.Н., Анненков М.В. Инфузионная терапия у новорожденных детей // Общая реаниматология. — 2008. — Т. 4, № 4. — С. 23-31.

http://meduniver.com/Medical/travmi/albumin_pri_cherepno-mozgovoi_travme.html MedUniver

SAFE Study Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group; Australian Red Cross Blood Service; George Institute for International Health. Saline or albumin for fluid resuscitation in patients with traumatic brain injury // N. Engl. J. Med. — 2007. — V. 357, № 9. — Р. 874-84.

Shin D.H., Moon G.J., Bang O.Y. Albumin therapy in acute stroke patients // J. Neurol. — 2007. — V. 254, № 7. — P. 870-8.

http://meduniver.com/Medical/travmi/albumin_pri_cherepno-mozgovoi_travme.html MedUniver

Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association / American Stroke Association // Stroke. — 2013. — V. 44. — Р. 870-947.

Rodling Wahlstrom M., Olivecrona M., Nystrom F., Koskinen L.O., Naredi S. Fluid therapy and the use of albumin in the treatment of severe traumatic brain injury // Acta Anaesthesiol. Scand. — 2009. — V. 53. — P. 18-25.

Vincent J.L., Naviсkis R., Wilkes M. Morbidity in hospitalized patients receiving human albumin analysis of randomized, controlled trials // Crit. Care Med. — 2004. — V. 32, № 10. — 2029-38.

Vincent J.L., Sakr Y., Reinhart K. et al. Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study // Critical. Care. — 2005. — № 9. — P. 745-754.




DOI: https://doi.org/10.22141/2224-0586.1.80.2017.94448

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru