Sepsis/InfectionFluid management in sepsis: The potential beneficial effects of albumin☆
Section snippets
Impact of plasma volume expansion on microvascular perfusion
Circulatory failure or shock is associated with a high risk of death and characterized by hemodynamic alterations that result in impaired tissue perfusion [1], [2]. Fluid resuscitation is one of the most frequent interventions used at the bedside to improve tissue perfusion, especially in septic shock. In experimental models of sepsis, generous fluid administration is associated with improved survival [3], [4]. Fluids should also be given in a timely fashion. Compared to early administration,
Potential beneficial effects of albumin in patients
Since 2000, several large randomized controlled trials (RCTs) have been performed to clarify the efficacy and safety of volume resuscitation in critically ill patients. The results of these studies have encouraged new thinking about the role of artificial colloids and paved the way for the development of lower risk crystalloids. In contrast to results of small trials using nonvalidated surrogate markers, several large RCTs have confirmed an increased need for renal replacement therapy and a
Conclusions and future directions
The plasma-expanding effects of crystalloids and colloids are decreased in conditions of increased permeability, but the extent and duration of plasma expansion remain higher with colloids than with crystalloids. Both types of fluid can increase microvascular perfusion, but there is marked individual variability in this effect. The impact of the type of fluid on microvascular perfusion and function needs to be better defined.
Albumin has pleiotropic physiological activities, including
Acknowledgments
This review is based on the lectures presented at the satellite symposium organized by Grifols, manufacturer of albumin, held on February 6, 2015, in Barcelona (Spain), in the context of the 20th International Symposium on Infections in the Critically Ill Patient.
Jordi Bozzo, PhD, CMPP, and Eva Medina (Grifols) are acknowledged for their editorial assistance in the preparation of the manuscript.
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Conflicts of interest: JLV declares no conflict of interest regarding this manuscript. DDB declares receiving honoraria as a speaker for Grifols. CW declares receiving honoraria as a speaker for Kedrion, CSL Behring, Baxter, and Grifols and as a consultant for CSL Behring and Grifols.