The following is a summary of “Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study,” published in the February 2024 issue of Critical Care by Gabarre et al.
Researchers conducted a prospective study to assess whether albumin’s potential protective properties translate to improved blood flow in sepsis-associated tissues.
They involved patients with sepsis, both with and without shock, and prolonged capillary refill time (CRT) greater than 3 seconds despite initial resuscitation. The clinicians treating these patients could administer either 500 milliliters of saline or 100 milliliters of 20% human serum albumin over 15 minutes. Evaluated global hemodynamic parameters and peripheral tissue perfusion at 1h (H1) and 4h (H4), aiming for CRT normalization (< 3 seconds) by H1.
The results showed 62 patients screened, with 50 patients (13 with sepsis and 37 with septic shock), 21 in the saline group, and 29 in the albumin group. The SOFA score was 8 [5–11], and the SAPS II was 53 [45–70]. The median age was 68 [60–76] years with a male predominance (74%). The primary infection sources were respiratory (54%) and abdominal (24%). Baseline comorbidities and clinical characteristics were similar between groups. At H1, CRT normalization (< 3 s) was more frequent in the albumin group compared to the saline group (63% vs 29%, P=0.02). The decreased fingertip CRT and mottling score were more significant in the albumin group when compared to the saline group (− 1.0 [− 0.3; − 1.5] vs − 0.2 [− 0.1; − 1.1] seconds, P = 0.04). At H4, albumin maintained its beneficial effects on peripheral tissue perfusion, with a trend towards higher urinary output (1.1 [0.5–1.8] vs 0.7 [0.5–0.9] ml/kg/h, P=0.08). Arterial lactate levels significantly decreased in the albumin group from H0 to H4 (P=0.03), while there was no significant change in the saline group.
Investigators concluded that albumin may have outperformed saline in improving tissue perfusion in patients with resuscitated sepsis.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04827-0
