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J Neurosurg Anesthesiol. 2021 Oct 01;33(4):293-299. doi: 10.1097/ANA.0000000000000674.

Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies.

Journal of neurosurgical anesthesiology

Heung Kan Ma, John F Bebawy

Affiliations

  1. Northwestern University Feinberg School of Medicine, Chicago, IL.

PMID: 31929351 DOI: 10.1097/ANA.0000000000000674

Abstract

Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

  1. Vincent JL, De Backer D, Wiedermann CJ. Fluid management in sepsis: the potential beneficial effects of albumin. J Crit Care. 2016;35:161–167. - PubMed
  2. Caironi P, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus. 2009;7:259–267. - PubMed
  3. Charles A, Purtill M, Dickinson S, et al. Albumin use guidelines and outcome in a surgical intensive care unit. Arch Surg. 2008;143:935–939. - PubMed
  4. Vincent JL, Russell JA, Jacob M, et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014;18:231. - PubMed
  5. Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370:1412–1421. - PubMed
  6. Quintero E, Gines P, Arroyo V, et al. Paracentesis versus diuretics in the treatment of cirrhotics with tense ascites. Lancet. 1985;1:611–612. - PubMed
  7. Martelli A, Strada P, Cagliani I, et al. Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines. Curr Ther Res Clin Exp. 2003;64:676–684. - PubMed
  8. Uhlig C, Silva PL, Deckert S, et al. Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care. 2014;18:R10. - PubMed
  9. Caraceni P, Tufoni M, Bonavita ME. Clinical use of albumin. Blood Transfus. 2013;11(suppl 4):s18–s25. - PubMed
  10. Lillemae K, Laine AT, Schramko A, et al. Effect of albumin in combination with mannitol on whole-blood coagulation in vitro assessed by thromboelastometry. J Neurosurg Anesthesiol. 2018;30:265–272. - PubMed
  11. Palmaers T, Hinsenkamp J, Kramer E, et al. Albumin combined with Mannitol impairs whole blood coagulation and platelet function in vitro. J Neurosurg Sci. 2019. [Epub ahead of print]. - PubMed
  12. Ronald Miller NC, Eriksson L, Fleisher L, et al. Miller’s Anesthesia, 8th ed. Philadelphia, PA: Saunders; 2014. - PubMed
  13. CSL Behring (Australia) Pty Ltd. Albumex® 4, Human albumin 40 g/L—Australia Product Information. 2018. Available at: https://www.medsafe.govt.nz/Profs/Datasheet/a/Albumex4inf.pdf. Accessed September 20, 2019. - PubMed
  14. Finfer S, Myburgh J, Bellomo R. Intravenous fluid therapy in critically ill adults. Nat Rev Nephrol. 2018;14:541–557. - PubMed
  15. Grifols Therapeutics LLC. Product Monograph—Plasbumin®-5, Albumin (Human) 5%, USP. 2018. Available at: www.grifols.com/documents/17006/133313/Plasbumin-5-en.pdf/ab42326e-cfac-4a43-87df-d74b069fe06a. Accessed September 20, 2019. - PubMed
  16. Schomerus H, Mayer G. Synthesis rates of albumin and fibrinogen in patients with protein-losing enteropathy and in a patient recovering from protein malnutrition. Digestion. 1975;13:201–208. - PubMed
  17. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth. 2000;85:599–610. - PubMed
  18. Weil MH, Henning RJ, Puri VK. Colloid oncotic pressure: clinical significance. Crit Care Med. 1979;7:113–116. - PubMed
  19. Morissette MP. Colloid osmotic pressure: its measurement and clinical value. Can Med Assoc J. 1977;116:897–900. - PubMed
  20. Weil MH, Morissette M, Michaels S, et al. Routine plasma colloid osmotic pressure measurements. Crit Care Med. 1974;2:229–234. - PubMed
  21. Pillinger NL, Kam P. Endothelial glycocalyx: basic science and clinical implications. Anaesth Intensive Care. 2017;45:295–307. - PubMed
  22. van der Jagt M. Fluid management of the neurological patient: a concise review. Crit Care. 2016;20:126. - PubMed
  23. Ertmer C, Van Aken H. Fluid therapy in patients with brain injury: what does physiology tell us? Crit Care. 2014;18:119. - PubMed
  24. Varatharaj A, Galea I. The blood-brain barrier in systemic inflammation. Brain Behav Immun. 2017;60:1–12. - PubMed
  25. Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009;23:183–191. - PubMed
  26. Huh PW, Belayev L, Zhao W, et al. The effect of high-dose albumin therapy on local cerebral perfusion after transient focal cerebral ischemia in rats. Brain Res. 1998;804:105–113. - PubMed
  27. Belayev L, Pinard E, Nallet H, et al. Albumin therapy of transient focal cerebral ischemia: in vivo analysis of dynamic microvascular responses. Stroke. 2002;33:1077–1084. - PubMed
  28. Belayev L, Liu Y, Zhao W, et al. Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke. 2001;32:553–560. - PubMed
  29. Wang L, Li M, Xie Y, et al. Preclinical efficacy of human albumin in subarachnoid hemorrhage. Neuroscience. 2017;344:255–264. - PubMed
  30. CSL Behring LLC. Albumin (Human) 5% solution AlbuRx® 5—Prescribing Information. 2014. Available at: http://labeling.cslbehring.com/PI/US/AlbuRx5/EN/AlbuRx5-Prescribing-Information.pdf. Accessed August 8, 2019. - PubMed
  31. Lai AT, Zeller MP, Millen T, et al. Chloride and other electrolyte concentrations in commonly available 5% albumin products. Crit Care Med. 2018;46:e326–e329. - PubMed
  32. Moritz ML. Why 0.9% saline is isotonic: understanding the aqueous phase of plasma and the difference between osmolarity and osmolality. Pediatr Nephrol. 2019;34:1299–1300. - PubMed
  33. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–1757. - PubMed
  34. Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics. 2011;8:319–329. - PubMed
  35. Che R, Huang X, Zhao W, et al. Low serum albumin level as a predictor of hemorrhage transformation after intravenous thrombolysis in ischemic stroke patients. Sci Rep. 2017;7:7776. - PubMed
  36. Ginsberg MD, Palesch YY, Martin RH, et al. The albumin in acute stroke (ALIAS) multicenter clinical trial: safety analysis of part 1 and rationale and design of part 2. Stroke. 2011;42:119–127. - PubMed
  37. Ginsberg MD, Palesch YY, Hill MD, et al. High-dose albumin treatment for acute ischaemic stroke (ALIAS) part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurol. 2013;12:1049–1058. - PubMed
  38. Martin RH, Yeatts SD, Hill MD, et al. ALIAS (Albumin in Acute Ischemic Stroke) trials: analysis of the combined data from parts 1 and 2. Stroke. 2016;47:2355–2359. - PubMed
  39. Oddo M, Poole D, Helbok R, et al. Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations. Intensive Care Med. 2018;44:449–463. - PubMed
  40. Mijiti M, Mijiti P, Axier A, et al. Incidence and predictors of angiographic vasospasm, symptomatic vasospasm and cerebral infarction in chinese patients with aneurysmal subarachnoid hemorrhage. PLoS One. 2016;11:e0168657. - PubMed
  41. Suarez JI. Diagnosis and management of subarachnoid hemorrhage. Continuum (Minneap Minn). 2015;21:1263–1287. - PubMed
  42. Rowland MJ, Hadjipavlou G, Kelly M, et al. Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth. 2012;109:315–329. - PubMed
  43. Suarez JI, Shannon L, Zaidat OO, et al. Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage. J Neurosurg. 2004;100:585–590. - PubMed
  44. Kapoor A, Dhandapani S, Gaudihalli S, et al. Serum albumin level in spontaneous subarachnoid haemorrhage: more than a mere nutritional marker! Br J Neurosurg. 2018;32:47–52. - PubMed
  45. Suarez JI, Martin RH, Calvillo E, et al. The Albumin in Subarachnoid Hemorrhage (ALISAH) multicenter pilot clinical trial: safety and neurologic outcomes. Stroke. 2012;43:683–690. - PubMed
  46. Todd MM, Hindman BJ, Clarke WR, et al. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med. 2005;352:135–145. - PubMed
  47. Suarez JI, Martin RH, Calvillo E, et al. Effect of human albumin on TCD vasospasm, DCI, and cerebral infarction in subarachnoid hemorrhage: the ALISAH study. Acta Neurochir Suppl. 2015;120:287–290. - PubMed
  48. Sacco S, Marini C, Toni D, et al. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40:394–399. - PubMed
  49. Gonzalez-Perez A, Gaist D, Wallander MA, et al. Mortality after hemorrhagic stroke: data from general practice (The Health Improvement Network). Neurology. 2013;81:559–565. - PubMed
  50. Limaye K, Yang JD, Hinduja A. Role of admission serum albumin levels in patients with intracerebral hemorrhage. Acta Neurol Belg. 2016;116:27–30. - PubMed
  51. Kidwell C. Albumin for intracerebral hemorrhage intervention—full text view—ClinicalTrials.gov. 2014. Available at: https://clinicaltrials.gov/ct2/show/NCT00990509. Accessed August 8, 2019. - PubMed
  52. Zeeni C, Carabini LM, Gould RW, et al. The implementation and efficacy of the Northwestern High Risk Spine Protocol. World Neurosurg. 2014;82:e815–e823. - PubMed
  53. Hollenhorst RW, Svien HJ, Benoit CF. Unilateral blindness occurring during anesthesia for neurosurgical operations. AMA Arch Ophthalmol. 1954;52:819–830. - PubMed
  54. Myers MA, Hamilton SR, Bogosian AJ, et al. Visual loss as a complication of spine surgery. A review of 37 cases. Spine (Phila Pa 1976). 1997;22:1325–1329. - PubMed
  55. Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009;109:1534–1545. - PubMed
  56. Ho VT, Newman NJ, Song S, et al. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005;17:38–44. - PubMed
  57. Stevens WR, Glazer PA, Kelley SD, et al. Ophthalmic complications after spinal surgery. Spine (Phila Pa 1976). 1997;22:1319–1324. - PubMed
  58. Rubin DS, Parakati I, Lee LA, et al. Perioperative visual loss in spine fusion surgery: ischemic optic neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample. Anesthesiology. 2016;125:457–464. - PubMed
  59. Roth S, Barach P. Postoperative visual loss: still no answers—yet. Anesthesiology. 2001;95:575–577. - PubMed
  60. Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med. 2015;372:2428–2436. - PubMed
  61. Goyal A, Elminawy M, Alvi MA, et al. Ischemic optic neuropathy following spine surgery: case control analysis and systematic review of the literature. Spine (Phila Pa 1976). 2019;44:1087–1096. - PubMed
  62. Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116:15–24. - PubMed
  63. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–2256. - PubMed
  64. Farag E, Sessler DI, Kovaci B, et al. Effects of crystalloid versus colloid and the alpha-2 agonist brimonidine versus placebo on intraocular pressure during prone spine surgery: a factorial randomized trial. Anesthesiology. 2012;116:807–815. - PubMed
  65. [No authors listed]. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care. Anesthesiology. 2019;130:12–30. - PubMed
  66. Dewan MC, Rattani A, Gupta S, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019;130:1080–1097. - PubMed
  67. Tellier A, Marshall SC, Wilson KG, et al. The heterogeneity of mild traumatic brain injury: where do we stand? Brain Inj. 2009;23:879–887. - PubMed
  68. Maas A. Traumatic brain injury: changing concepts and approaches. Chin J Traumatol. 2016;19:3–6. - PubMed
  69. The SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–884. - PubMed
  70. Cooper DJ, Myburgh J, Heritier S, et al. Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality? J Neurotrauma. 2013;30:512–518. - PubMed
  71. von Berenberg P, Unterberg A, Schneider GH, et al. Treatment of traumatic brain edema by multiple doses of mannitol. Acta Neurochir Suppl (Wien). 1994;60:531–533. - PubMed
  72. Cho J, Kim YH, Han HS, et al. Accumulated mannitol and aggravated cerebral edema in a rat model of middle cerebral artery infarction. J Korean Neurosurg Soc. 2007;42:337–341. - PubMed
  73. Paczynski RP, He YY, Diringer MN, et al. Multiple-dose mannitol reduces brain water content in a rat model of cortical infarction. Stroke. 1997;28:1437–1443; discussion 1444. - PubMed
  74. Paczynski RP, Venkatesan R, Diringer MN, et al. Effects of fluid management on edema volume and midline shift in a rat model of ischemic stroke. Stroke. 2000;31:1702–1708. - PubMed
  75. Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992;77:584–589. - PubMed
  76. Iguchi N, Kosaka J, Bertolini J, et al. Differential effects of isotonic and hypotonic 4% albumin solution on intracranial pressure and renal perfusion and function. Crit Care Resusc. 2018;20:48–53. - PubMed
  77. Wen PY, Schiff D, Kesari S, et al. Medical management of patients with brain tumors. J Neurooncol. 2006;80:313–332. - PubMed
  78. Jungner M, Grande PO, Mattiasson G, et al. Effects on brain edema of crystalloid and albumin fluid resuscitation after brain trauma and hemorrhage in the rat. Anesthesiology. 2010;112:1194–1203. - PubMed

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