Haemodynamic and biochemical responses to fluid bolus therapy with human albumin solution, 4% versus 20%, in critically ill adults

Jonathan Bannard-Smith, Paschal Alexander, Neil John Glassford, Matthew J Chan, Matthew Lee, Benjamin T Wong, Grant Crawford, Michael John Bailey, Rinaldo Bellomo

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Abstract

Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of use in patients with traumatic brain injury, FBT with human albumin solution (HAS) appears safe and perhaps superior in severe sepsis. OBJECTIVE: To determine the physiological effects of FBT with 4 v 20 HAS. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study of 202 critically ill patients receiving FBT with HAS in a tertiary intensive care unit between April 2012 and March 2013. METHODS: FBT was instituted with 4 or 20 HAS, according to clinician preference. MAIN OUTCOME MEASURES: We compared biochemical and haemodynamic data between groups at baseline and at 1, 2 and 4 hours after FBT. RESULTS: Patients who had received 20 HAS had more liver disease, a greater need for renal replacement therapy and higher Acute Physiology and Chronic Health Evaluation III scores on admission. Patients who had received 4 HAS received a median volume of 500 mL (interquartile range [IQR], 350-500mL), compared with 100mL (IQR, 100- 200mL) in the 20 HAS group (P <0.0001); a median of 70mmol v 10mmol of sodium (P <0.0001); and a median of 64mmol v 2mmol of chloride (P <0.0001). There was a trend toward higher mean arterial pressures in the 20 group after FBT (78.2mmHg v 76.4mmHg, P = 0.03). There were no significant differences in the absolute or percentage change for any haemodynamic parameters. Serum biochemical test results were comparable with a non-significant signal of higher serum chloride and more negative base excess in patients receiving 4 HAS. CONCLUSIONS: Haemodynamically, FBT with 100mL of 20 HAS performs in an equivalent way to 500mL of 4 HAS but delivers much less fluid, sodium and chloride.
Original languageEnglish
Pages (from-to)122-128
Number of pages7
JournalCritical Care and Resuscitation
Volume17
Issue number2
Publication statusPublished - 2015

Cite this

Bannard-Smith, Jonathan ; Alexander, Paschal ; Glassford, Neil John ; Chan, Matthew J ; Lee, Matthew ; Wong, Benjamin T ; Crawford, Grant ; Bailey, Michael John ; Bellomo, Rinaldo. / Haemodynamic and biochemical responses to fluid bolus therapy with human albumin solution, 4% versus 20%, in critically ill adults. In: Critical Care and Resuscitation. 2015 ; Vol. 17, No. 2. pp. 122-128.
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abstract = "Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of use in patients with traumatic brain injury, FBT with human albumin solution (HAS) appears safe and perhaps superior in severe sepsis. OBJECTIVE: To determine the physiological effects of FBT with 4 v 20 HAS. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study of 202 critically ill patients receiving FBT with HAS in a tertiary intensive care unit between April 2012 and March 2013. METHODS: FBT was instituted with 4 or 20 HAS, according to clinician preference. MAIN OUTCOME MEASURES: We compared biochemical and haemodynamic data between groups at baseline and at 1, 2 and 4 hours after FBT. RESULTS: Patients who had received 20 HAS had more liver disease, a greater need for renal replacement therapy and higher Acute Physiology and Chronic Health Evaluation III scores on admission. Patients who had received 4 HAS received a median volume of 500 mL (interquartile range [IQR], 350-500mL), compared with 100mL (IQR, 100- 200mL) in the 20 HAS group (P <0.0001); a median of 70mmol v 10mmol of sodium (P <0.0001); and a median of 64mmol v 2mmol of chloride (P <0.0001). There was a trend toward higher mean arterial pressures in the 20 group after FBT (78.2mmHg v 76.4mmHg, P = 0.03). There were no significant differences in the absolute or percentage change for any haemodynamic parameters. Serum biochemical test results were comparable with a non-significant signal of higher serum chloride and more negative base excess in patients receiving 4 HAS. CONCLUSIONS: Haemodynamically, FBT with 100mL of 20 HAS performs in an equivalent way to 500mL of 4 HAS but delivers much less fluid, sodium and chloride.",
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Haemodynamic and biochemical responses to fluid bolus therapy with human albumin solution, 4% versus 20%, in critically ill adults. / Bannard-Smith, Jonathan; Alexander, Paschal; Glassford, Neil John; Chan, Matthew J; Lee, Matthew; Wong, Benjamin T; Crawford, Grant; Bailey, Michael John; Bellomo, Rinaldo.

In: Critical Care and Resuscitation, Vol. 17, No. 2, 2015, p. 122-128.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Haemodynamic and biochemical responses to fluid bolus therapy with human albumin solution, 4% versus 20%, in critically ill adults

AU - Bannard-Smith, Jonathan

AU - Alexander, Paschal

AU - Glassford, Neil John

AU - Chan, Matthew J

AU - Lee, Matthew

AU - Wong, Benjamin T

AU - Crawford, Grant

AU - Bailey, Michael John

AU - Bellomo, Rinaldo

PY - 2015

Y1 - 2015

N2 - Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of use in patients with traumatic brain injury, FBT with human albumin solution (HAS) appears safe and perhaps superior in severe sepsis. OBJECTIVE: To determine the physiological effects of FBT with 4 v 20 HAS. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study of 202 critically ill patients receiving FBT with HAS in a tertiary intensive care unit between April 2012 and March 2013. METHODS: FBT was instituted with 4 or 20 HAS, according to clinician preference. MAIN OUTCOME MEASURES: We compared biochemical and haemodynamic data between groups at baseline and at 1, 2 and 4 hours after FBT. RESULTS: Patients who had received 20 HAS had more liver disease, a greater need for renal replacement therapy and higher Acute Physiology and Chronic Health Evaluation III scores on admission. Patients who had received 4 HAS received a median volume of 500 mL (interquartile range [IQR], 350-500mL), compared with 100mL (IQR, 100- 200mL) in the 20 HAS group (P <0.0001); a median of 70mmol v 10mmol of sodium (P <0.0001); and a median of 64mmol v 2mmol of chloride (P <0.0001). There was a trend toward higher mean arterial pressures in the 20 group after FBT (78.2mmHg v 76.4mmHg, P = 0.03). There were no significant differences in the absolute or percentage change for any haemodynamic parameters. Serum biochemical test results were comparable with a non-significant signal of higher serum chloride and more negative base excess in patients receiving 4 HAS. CONCLUSIONS: Haemodynamically, FBT with 100mL of 20 HAS performs in an equivalent way to 500mL of 4 HAS but delivers much less fluid, sodium and chloride.

AB - Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of use in patients with traumatic brain injury, FBT with human albumin solution (HAS) appears safe and perhaps superior in severe sepsis. OBJECTIVE: To determine the physiological effects of FBT with 4 v 20 HAS. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study of 202 critically ill patients receiving FBT with HAS in a tertiary intensive care unit between April 2012 and March 2013. METHODS: FBT was instituted with 4 or 20 HAS, according to clinician preference. MAIN OUTCOME MEASURES: We compared biochemical and haemodynamic data between groups at baseline and at 1, 2 and 4 hours after FBT. RESULTS: Patients who had received 20 HAS had more liver disease, a greater need for renal replacement therapy and higher Acute Physiology and Chronic Health Evaluation III scores on admission. Patients who had received 4 HAS received a median volume of 500 mL (interquartile range [IQR], 350-500mL), compared with 100mL (IQR, 100- 200mL) in the 20 HAS group (P <0.0001); a median of 70mmol v 10mmol of sodium (P <0.0001); and a median of 64mmol v 2mmol of chloride (P <0.0001). There was a trend toward higher mean arterial pressures in the 20 group after FBT (78.2mmHg v 76.4mmHg, P = 0.03). There were no significant differences in the absolute or percentage change for any haemodynamic parameters. Serum biochemical test results were comparable with a non-significant signal of higher serum chloride and more negative base excess in patients receiving 4 HAS. CONCLUSIONS: Haemodynamically, FBT with 100mL of 20 HAS performs in an equivalent way to 500mL of 4 HAS but delivers much less fluid, sodium and chloride.

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