Administration of 25% human serum albumin, in conjunction with furosemide, reduced days of ventilator dependency and shock in hypoproteinemic ICU patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS), according to a newly released study supported by the National Institutes of Health.
This double-blinded, placebo-controlled trial randomized 40 ALI/ARDS patients to receive:
- Furosemide plus 25 g of 25% albumin, followed by doses of albumin every 8 hours for three days, or
- Furosemide plus an equivalent volume of placebo (saline solution).
No additional diuretic or colloid therapy was permitted during the study. In 40% of patients, sepsis was the cause of ALI, while in 45%, pneumonia or trauma were causes. Hypoproteinemia was defined as a serum total protein level of <6.0 g/dL.
Below are key outcomes from this trial:
There were seven deaths in the albumin treatment group (35% mortality) and nine deaths (45% mortality) in the saline control group (p = .52).
These clinical findings coincide with significant differences in measured values reflecting superior cardiopulmonary function in the albumin treatment group. In particular, these included cardiac index and the PaO
2/FiO
2 ratio.
The investigators conclude that "the combination of furosemide and albumin in therapy for hypoproteinemic ALI patients improves oxygenation...Consistent trends toward improved duration of mechanical ventilation are apparent from this and previous studies."
The full citation is: Martin GS, Moss M, Wheeler AP et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med 2005 Aug; 33(8):1681-7.
Click here to access this study.
