Albumin in critically ill patients

The use of albumin-containing solutions in critically ill patients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients.The revision of Starling's theory on microvascular fluid dynamics has highlighted the role of albumin in preserving intravascular compartment volume. In cirrhosis, albumin may be important in maintaining immune system reactivity and cardiac contractility. Preliminary analyses indicate albumin as beneficial in patients with burn, while being associated with increased risk of acute kidney injury after cardiac surgery. The first RCT (ALBIOS trial) testing the efficacy of albumin replacement in severe sepsis did not show a survival benefit associated with albumin, although observing at post-hoc analysis a benefit in septic shock. All the eight meta-analyses performed on albumin in sepsis reveal an absence of harm, and likely a benefit lower than expected, whereas suggesting an advantage, to be verified, in septic shock.Further studies are needed to clarify physiology and clinical impact of albumin in critically ill patients, considering specific phenotypes and secondary outcomes other than survival, yet clinically relevant.