What is the safest infusion for 5% albumin in patients with hypotension?

From the Guidelines

For hypotensive patients, the safest infusion for 5% albumin is typically 0.5-1 g/kg (10-20 mL/kg) administered intravenously at a rate of 2-4 mL/minute, as recommended by recent guidelines 1. This should be titrated based on the patient's hemodynamic response, with close monitoring of vital signs. The initial dose can be followed by additional doses if needed, but the total daily dose should generally not exceed 2 g/kg. Administration should be slowed or stopped if signs of volume overload develop, such as increased blood pressure, heart rate, or respiratory distress.

Key Considerations

• Albumin works by increasing oncotic pressure within the intravascular space, drawing fluid from the interstitial space into the circulation, thereby improving blood pressure.
• It's particularly useful in patients with hypoalbuminemia, but even in patients with normal albumin levels, it can help stabilize hemodynamics.
• Caution should be exercised in patients with cardiac failure, pulmonary edema, or severe anemia, as rapid volume expansion may worsen these conditions, as noted in guidelines for heart failure management 1.

Monitoring and Adjustments

• Close monitoring of vital signs, including blood pressure, heart rate, and respiratory rate, is essential during albumin infusion.
• The infusion rate should be adjusted based on the patient's response, and signs of volume overload should be promptly addressed.
• Other guidelines, such as those for acute ischemic stroke 1, may not be directly applicable to the use of albumin in hypotensive patients, but emphasize the importance of careful patient selection and monitoring.

From the FDA Drug Label

If the patient is dehydrated, additional crystalloids must be given,(4) or alternatively, Albumin (Human) 5%, USP (Plasbumin®-5) should be used. The patient’s hemodynamic response should be monitored and the usual precautions against circulatory overload observed.

The safest infusion for 5% albumin in patients with hypotension is to use Albumin (Human) 5%, USP (Plasbumin®-5), and to monitor the patient's hemodynamic response. Additionally, precautions against circulatory overload should be observed. If the patient is dehydrated, additional crystalloids must be given. 2

From the Research

Safest Infusion for 5% Albumin in Patients with Hypotension

• The safest infusion for 5% albumin in patients with hypotension is not explicitly stated in the provided studies, but some insights can be gathered from the available data 3, 4, 5, 6, 7.
• A study from 2021 compared 5% human albumin and normal saline for fluid resuscitation in sepsis-induced hypotension among patients with cirrhosis, and found that 5% albumin was safe and beneficial in reversing hypotension 6.
• Another study from 1997 compared the efficacy of 5% albumin and isotonic saline solution for treating hypotension in preterm infants, and found that isotonic saline was as effective as 5% albumin, with the additional advantage of causing less fluid retention 7.
• The importance of infusion rate for plasma volume expansion following major abdominal surgery was investigated in a 2016 study, which suggested that a slow infusion of resuscitation fluid may result in better plasma volume expansion than a rapid infusion 5.
• A case report from 2007 described anaphylactoid shock in a patient following 5% human serum albumin infusion during off-pump coronary artery bypass grafting, highlighting the potential risks associated with 5% albumin infusion 3.
• The hemodynamic effects of rapid fluid infusion in critically ill patients were studied in 1981, and the results suggested that the response to fluid infusion is complex and depends on various factors, including left ventricular function and peripheral vascular resistance 4.

Key Findings

• 5% albumin may be safe and beneficial in reversing hypotension in certain patient populations, such as those with cirrhosis 6.
• Isotonic saline may be as effective as 5% albumin for treating hypotension in preterm infants, with the additional advantage of causing less fluid retention 7.
• The infusion rate of resuscitation fluid may impact plasma volume expansion, with slow infusions potentially resulting in better expansion than rapid infusions 5.
• Anaphylactoid reactions can occur with 5% albumin infusion, highlighting the need for careful monitoring and caution when administering this fluid 3.