Effect of albumin with furosemide in adult respiratory distress syndrome

Background

Albumin with furosemide has been reported to improve cardiovascular stability and oxygenation in adult respiratory distress syndrome (ARDS) [1].

Method

Fourteen patients meeting the ARDS criteria of PO₂/FiO₂ ratio < 27 kPa (200 mmHg) plus bilateral X-ray shadowing without cardiac cause, were recruited at the Chelsea and Westminster Hospital, London. Oxygenation and cardiovascular parameters were measured before (t0) and 5 min (t5) and 240 min (t240) after rapid intravenous administration of 200 ml of 20% human albumin solution (BPL) with 20 mg furosemide. Results were analysed by ANOVA with Bonferonni/Dunn post-hoc significance testing, with P < 0.05 considered significant. Albumin concentrations were corrected for changes in plasma volume.

Results

Expressed as mean (SD). Both colloid osmotic pressure (COP) and albumin changed significantly, with significant immediate elevation at t5 that declined by t240, although elevation above baseline remained significant. Plasma albumin was 13(3.8) g/dl at t0, 17.4 (6.1) g/dl at t5, and 16.7 (4.7) g/dl at t240. COP was 16.1 (2) mmHg at t0, 19 (2.5) mmHg at t5 and 17.3 (2.4) mmHg at t240. Significant changes also occurred in both PO₂/FiO₂ and central venous pressure (CVP) but significant increases at t5 were not sustained at t240. PO₂/FiO₂ was 19.9 (4.1) kPa at t0, 22.3 (5.8) kPa at t5, and 20.6 (6) kPa at t240. CVP was 17 (6) mmHg at t0, 20 (5) mmHg at t5, and 18 (5) mmHg at t240.

The heart rate and cardiac output were not significantly affected by albumin administration, although an increase in cardiac output correlated nonsignificantly with improvement in the PO₂/FiO₂ ratio at t5 (correlation 0.43) and at t240 (correlation 0.40).

Discussion

Cardiovascular stability was unaffected by albumin and furosemide administration. An immediate improvement in oxygenation was not sustained at 4 hours.