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Table 2 Randomized clinical trials of hyperoncotic albumin in sepsis

From: Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials

Trial n Indication Regimen Results
Boldt et al., 1995 [44] 30 Sepsis after major surgery 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both Plasma thrombomodulin increased in albumin group and remained unchanged in HES 200/0.5 group (p < 0.05); plasma protein C among HES 200/0.5 recipients increased on days 4 and 5 without corresponding change in albumin group (p < 0.05)
Boldt et al., 1996 [45] 30 Sepsis secondary to major general surgery 20% albumin vs 10% HES 200/0.5 to 12–18 mm Hg target PCWP HES 200/0.5 but not albumin increased cardiac index, RVEF, PaO2/FiO2, DO2I and VO2I and decreased SVRI (p < 0.05 for all comparisons); pHi decreased in albumin but not HES 200/0.5 group (p < 0.05)
Boldt et al., 1996 [46] 28 Sepsis after major surgery 20% albumin vs 10% HES 200/0.5 to 12–16 mm Hg target CVP, PCWP or both Maximum platelet aggregation declined in both groups (p < 0.05)
Boldt et al., 1996 [47] 42 Sepsis secondary to major surgery 20% albumin vs 6% HES 200/0.5 vs pentoxyfylline (300 mg bolus plus 1.4 mg/kg/h continuous infusion) Circulating sELAM-1 and sICAM-1 concentrations reduced by HES 200/0.5 compared with albumin (p < 0.05 for both comparisons)
Boldt et al., 1996 [48] 28 Sepsis secondary to major surgery 20% albumin vs 10% HES 200/0.5 to 10–15 mm Hg target PCWP Vasopressin, endothelin-1, norepinephrine and 6-keto-prostaglandin F1a decreased and pHi increased in HES 200/0.5 but not albumin group (p < 0.05 for all comparisons); ANP increased by albumin but not HES 200/0.5 (p < 0.05)
Boldt et al., 1998 [49] 150 Postoperative sepsis 20% albumin vs 10% HES 200/0.5 to 12–15 mm Hg target PCWP PaO2/FiO2 increased and lactate decreased by HES 200/0.5 but not albumin (p < 0.05 for both comparisons); higher cardiac index, DO2I and VO2I in HES 200/0.5 group (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT
Palumbo et al., 2006 [59] 20 Severe sepsis 20% albumin vs 6% HES 130/0.4 PCWP of 15–18 mm Hg successfully maintained by both colloids throughout the 5-day study period; temperature, MAP, pulmonary artery pressure, CVP, heart rate and urine output remained stable in both groups; HES increased cardiac index and several oxygenation parameters and decreased APACHE II score
  1. ANP, atrial natriuretic peptide; APACHE, Acute Physiology and Chronic Health Evaluation; aPTT, activated partial thromboplastin time; CVP, central venous pressure; DO2I, oxygen delivery index; HES, hydroxyethyl starch; MAP, mean arterial pressure; PaO2/FiO2, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; PCWP, pulmonary capillary wedge pressure; pHi, gastric intramucosal pH; PT, prothrombin time; RVEF, right ventricular ejection fraction; sELAM-1, soluble endothelial leukocyte adhesion molecule-1; sICAM-1, soluble intercellular adhesion molecule-1; SVRI, systemic vascular resistance index; VO2I, oxygen consumption index.
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Critical Care

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