Albumin Administration Superior to Ringer’s Lactate for Maintaining Normovolemia During Major Surgical Hemorrhage

With the aim of better understanding the plasma volume expansion effects of albumin solutions during surgery associated with major hemorrhage, Swiss investigators at the Bern University Hospital conducted a single-center randomized clinical trial to quantify and compare the PVE properties of iso-oncotic 5% albumin, hyper-oncotic 20% albumin and Ringer’s lactate (RL) in patients undergoing radical cystectomy.

To combat intraoperative hypovolemia, 42 consecutive patients were randomly allocated to receive 5% albumin (12 mL/kg) or 20% albumin (3 mL/kg) over 30 minutes of the hemorrhagic phase of their surgery, together with RL to replace blood loss at a 1:1 ratio, or RL alone to replace blood loss in a 3:1 ratio. The median hemorrhage volume across all patients was 848 mL (interquartile range 615-1145 mL).

The RL solution expanded the plasma volume by 0.18 times the infused volume, while 5% and 20% albumin solutions, respectively, attained plasma volume expansion of 0.74 and 2.09 times the infused volume. While the RL-only group experienced modest hypovolemia (a mean of -313 mL), the 5% and 20% albumin solutions were more effective in filling the vascular system, with calculated blood volume changes of only +63 mL and -44 mL, respectively. The two albumin solutions also 1) increased central venous pressure relative to RL and 2) achieved long-lasting plasma volume expansion with median half-times of 5.5 hours and 4.8 hours, respectively.

The study investigators pointed out that administration of albumin combined with restricted administration of RL reduces positive fluid balance. “This is of importance as excessive postoperative fluid balance has been related to poorer outcomes, including postoperative complications like anastomotic leakage in major surgery involving intestines or colon,” they added.