Can albumin be administered to a patient with hypotension, a mean arterial pressure (MAP) of 60, and tachycardia, with a blood pressure of 78/51 mmHg and a heart rate of 84 beats per minute?

From the Guidelines

You can administer albumin to this patient with a MAP of 60 mmHg, as it is an appropriate intervention to help increase intravascular volume and improve blood pressure, according to the Surviving Sepsis Campaign guidelines 1.

Patient Assessment

The patient's blood pressure has been running low all night, with a recent reading of 78/51 mmHg, resulting in a mean arterial pressure (MAP) of 60 mmHg. The heart rate is 84 beats per minute.

Treatment Recommendations

The standard dose of albumin is typically 25g (100mL of 25% solution) or 50g (200mL of 25% solution) administered intravenously over 30-60 minutes 1.

• Monitor the patient's vital signs closely during and after administration, particularly blood pressure and heart rate.
• Reassess the MAP after completion of the infusion to determine if additional interventions are needed.

Mechanism of Action

Albumin works by increasing oncotic pressure within the vasculature, drawing fluid from the interstitial space into the bloodstream, thereby increasing blood volume and improving hemodynamics.

Underlying Cause

While administering albumin, also investigate the underlying cause of hypotension, as albumin provides temporary support but does not address the root cause of the patient's low blood pressure.

Guidelines

The use of albumin in fluid resuscitation of patients with sepsis and septic shock is suggested when patients require substantial amounts of crystalloids, according to the Surviving Sepsis Campaign guidelines 1.

• Crystalloids are recommended as the fluid of choice for initial resuscitation and subsequent intravascular volume replacement in patients with sepsis and septic shock 1.
• The guidelines also recommend against using hydroxyethyl starches for intravascular volume replacement in patients with sepsis or septic shock 1.

From the FDA Drug Label

Patients should always be monitored carefully in order to guard against the possibility of circulatory overload. Plasbumin-25 is hyperoncotic, therefore, in the presence of dehydration, albumin must be given with or followed by addition of fluids. In hemorrhage the administration of albumin should be supplemented by the transfusion of whole blood to treat the relative anemia associated with hemodilution. Certain patients, e.g., those with a history of congestive cardiac failure, renal insufficiency or stabilized chronic anemia, are at special risk of developing circulatory overload.

The patient's blood pressure is low (78/51) with a mean arterial pressure (MAP) of 60 and a heart rate of 84. Hypovolemic shock may be a concern, but the patient's hemodynamic response should be monitored, and precautions against circulatory overload should be observed.

• The patient's low blood pressure and MAP may indicate hypovolemia, but the use of albumin should be cautious, and the patient's response to treatment should be closely monitored.
• Key considerations include the patient's fluid status, cardiovascular function, and potential risks of circulatory overload. The FDA drug label does not provide a clear answer to whether albumin can be given in this specific situation, as it depends on various factors, including the patient's underlying condition, fluid status, and potential risks 2, 2, 2.

From the Research

Patient Assessment

• The patient's blood pressure has been running low all night, with a recent reading of 78/51, resulting in a mean arterial pressure (MAP) of 60.
• The patient's heart rate is 84.
• The question is whether albumin can be given to the patient.

Albumin Administration

• According to the study 3, albumin use in septic shock was not associated with additional days alive and free of vasopressors or in-hospital mortality.
• The study 4 found that human albumin solutions as part of fluid volume expansion and resuscitation for critically unwell adults with sepsis of any severity were not robustly effective at reducing all-cause mortality.
• However, the study 3 suggested that albumin may reduce the duration of vasopressor use in septic shock, although this was not confirmed in the propensity score-matched analysis.

Mean Arterial Pressure (MAP)

• The study 5 demonstrated a non-linear relationship between MAP and 30-day mortality in patients with sepsis, with a strong predictor of potential risk of sepsis death when MAP was less than 68.6 mmHg.
• The patient's current MAP of 60 is below the inflection point of 68.6 mmHg, which may indicate a higher risk of mortality.

Decision to Administer Albumin

• Based on the available evidence 3, 4, albumin may not be effective in reducing mortality or improving outcomes in septic patients.
• However, the patient's low MAP and potential risk of mortality may require careful consideration of albumin administration as part of a broader treatment strategy, taking into account the patient's individual clinical context and the potential benefits and risks of albumin therapy 6, 7.