It should be recognized that all four trials in this category involved distinct types of brain insults. The varying pathologic mechanisms at work in these groups of patients are likely to require different approaches to fluid management, for instance, due to increased intracranial pressure in patients with head trauma.
This systematic review revealed evidence of clinical benefit due to albumin administration, for instance by reducing morbidity in a variety of clinical settings. Cardiac surgery is among the predominant indications of albumin administration. In cardiac surgery, albumin was devoid of the detrimental effects exerted by crystalloids, such as respiratory impairment and pulmonary oedema, which may be attributable to crystalloid-mediated reductions in COP and COP-PAWP gradient [93,94].
The hypoalbuminaemia trials were instructive, in that dose effects were remarkably effective in resolving apparent inconsistencies in results. Indeed, these inconsistencies have often prompted the interpretation that albumin is of little value when administered for correction of hypoalbuminaemia. However, in this review albumin clearly bestowed clinical benefit when administered in doses adequate to raise the serum albumin concentration above 30 g L−1. The therapeutic rationale for correcting hypoalbuminaemia rests upon the well-recognized association between lower serum albumin and poor outcome. Multivariate models derived from the results of numerous cohort studies have revealed hypoalbuminaemia to be a potent independent predictor of mortality, morbidity and other adverse outcomes, suggesting that serum albumin exerts a direct protective effect. For instance, in one such study involving 54 215 non-cardiac surgery patients, both mortality and morbidity increased progressively as serum albumin decreased over the range of albumin concentrations between 22 and 46 g L−1.
In no category is the evidence of clinical benefits due to albumin more consistent than ascites. These benefits include reduced morbidity, length of stay and treatment cost. In ascites patients progressing to spontaneous bacterial peritonitis, a significant survival benefit of albumin has also been demonstrated .
It is often recommended that albumin be administered with caution in states of increased endothelial permeability, such as sepsis. However, a previous review of preclinical and clinical evidence failed to support the concept of increased lung water or compromised lung function with the administration of colloids . On the contrary, among the RCTs included in this review there was evidence of reduced pulmonary oedema and improved respiratory function in sepsis patients receiving albumin. Deleterious effects of HES on coagulation function were also apparent in this indication.
The optimal time for albumin administration in burn patients remains unresolved. In this review, albumin reduced morbidity in burned patients. Furthermore, this benefit was attained with immediate use of albumin. Delaying albumin administration for 24 h is commonly advocated for fluid management of thermal injury.
In patients with brain injury, albumin-containing regimens reduced mortality, disability and neurological deficits. By contrast, serious safety problems associated with HES have been reported in this setting [104,105]. For instance, two RCTs of HES for acute ischaemic stroke had to be stopped prematurely due to unexpected morbidity and mortality in HES recipients [106,107]. Indeed, the consistent evidence of adverse effects attributable to HES in this review clearly indicates that all colloids are not equal.
What mechanisms might account for the observed benefits of albumin? The role of albumin in maintaining COP is well recognized. However, this ability is shared by other colloids, such as HES, which nevertheless fail to confer comparable clinical benefit. This may in part be attributed to side-effects of artificial colloids, such as interference with coagulation by HES through reductions in factor VIII, von Willebrand factor and platelets, impairment of platelet function and enhancement of fibrinolysis, as elsewhere reviewed .
Besides the absence of deleterious effects due to artificial colloid, some of the additional protective properties of albumin are likely to be of importance, e.g. its antioxidant activity and binding affinity for lipids, drugs, toxic substances and other ligands. Other potential protective effects of albumin are inhibition of apoptosis  and, probably of greater importance, modulation of inflammatory response .
In this review, all RCTs comparing albumin with various control regimens were considered, rather than the subset of trials reporting data with respect to a particular end-point, such as mortality. Consequently, the scope of this review - 79 trials with 4755 total patients - is far larger than that of any prior review on this topic, including the previous meta-analyses on survival after albumin therapy [4,5]. This review also focused exclusively on end-points that the included trials were designed to assess, thereby avoiding the potential distortions of investigating an outcome such as death a posteriori in trials not designed to address this end-point.
A substantial number of included trials failed to detect differences between albumin and control with respect to clinically important end-points, hence supporting the contention that albumin therapy is without benefit. However, because of the small size of most included trials, failure to detect benefit might be due to lack of statistical power rather than of albumin effectiveness. Another likely explanation for absence of between-group differences in some trials was the presence of confounding factors [10,11,18,24].
Importantly, clear evidence of unfavourable effects attributable to albumin has rarely been reported. If albumin were devoid of overall benefit, a population of trials such as that in this review would be expected to yield favourable, neutral and unfavourable effects of albumin. The infrequency of unfavourable results is consistent with the conclusion that the overall impact of albumin therapy is beneficial.
The potential contribution of publication bias must be considered. It is possible that trials demonstrating statistically significant benefits of albumin were more likely to be reported than those that did not. However, publication bias can operate in either direction, i.e. over-reporting or under-reporting of beneficial results. The potential for under-reporting of benefit arises from the design of many RCTs, which were undertaken to demonstrate the equivalence of albumin with less expensive alternative fluids. Indeed, in the most recent meta-analysis of survival after albumin administration, significant publication bias was observed . In that meta-analysis trials with mortality results favourable to albumin were more likely to be unreported. Consequently, in the present review publication bias, if any, might tend to cause albumin benefit to be under- rather than overestimated.
Based on this systematic review of RCTs, beneficial effects of albumin are apparent in a wide array of clinical settings. Nevertheless, the results of the review, particularly in the hypoalbuminaemia and burn trials, suggest that optimal dose and administration schedules for albumin remain to be delineated, and further investigations are warranted to address these issues, as well as to define more precisely the appropriate roles for albumin in particular indications and patient populations.
This work was supported through an unrestricted grant from the Plasma Protein Therapeutics Association.
1. Woodruff LM, Gibson ST. The use of human albumin in military medicine. Part II. The clinical evaluation of human albumin. US Navy Med Bull
2. Janeway CA, Gibson ST, Woodruff LM, et al.
Chemical, clinical and immunological studies on the products of human plasma fractionation. VII. Concentrated human serum albumin
. J Clin Invest
3. Boldt J. The good, the bad, and the ugly: should we completely banish human albumin from our intensive care units? Anesth Analg
4. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ
5. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med
6. von Hoegen I, Waller C. Safety of human albumin based on spontaneously reported serious adverse events. Crit Care Med
7. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med
8. McMurray L-G, Roe JH, Sweet LK. Plasma protein studies on normal newborn and premature infants. I. Plasma protein values for normal full term and normal premature infants. II. Use of concentrated normal human serum albumin
in treatment of premature infants. Am J Dis Child
9. Recinos PR, Hartford CA, Ziffren SE. Fluid resuscitation of burn patients comparing a crystalloid with a colloid containing solution: a prospective study. J Iowa Med Soc
10. Lowe RJ, Moss GS, Jilek J, Levine HD. Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man. Surgery
11. Moss GS, Lowe RJ, Jilek J, Levine HD. Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial. Surgery
12. Shah DM, Browner BD, Dutton RE, Newell JC, Powers Jr SR. Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients. Arch Surg
13. Hallowell P, Bland JH, Dalton BC, et al.
The effect of hemodilution with albumin or Ringer's lactate on water balance and blood use in open-heart surgery
. Ann Thorac Surg
14. Boutros AR, Ruess R, Olson L, Hoyt JL, Baker WH. Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta. Crit Care Med
15. Jelenko 3rd C, Williams JB, Wheeler ML, et al.
Studies in shock and resuscitation. I. Use of a hypertonic, albumin-containing, fluid demand regimen (HALFD) in resuscitation. Crit Care Med
16. Virgilio RW, Rice CL, Smith DE, et al.
Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery
17. Mathru M, Rao TL, Kartha RK, Shanmugham M, Jacobs HK. Intravenous albumin administration for prevention of spinal hypotension during cesarean section. Anesth Analg
18. Nilsson E, Lamke LO, Liljedahl SO, Elfström K. Is albumin therapy worthwhile in surgery
for colorectal cancer? Acta Chir Scand
19. Zetterström H, Hedstrand U. Albumin treatment following major surgery
. I. Effects on plasma oncotic pressure, renal function and peripheral oedema. Acta Anaesthesiol Scand
20. Zetterström H. Albumin treatment following major surgery
. II. Effects on postoperative lung function and circulatory adaptation. Acta Anaesthesiol Scand
21. Öhqvist G, Settergren G, Bergstrom K, Lundberg S. Plasma colloid osmotic pressure during open-heart surgery
using non-colloid or colloid priming solution in the extracorporeal circuit. Scand J Thorac Cardiovasc Surg
22. Öhqvist G, Settergren G, Lundberg S. Pulmonary oxygenation, central haemodynamics and glomerular filtration following cardiopulmonary bypass with colloid or non-colloid priming solution. Scand J Thorac Cardiovasc Surg
23. Diehl JT, Lester 3rd JL, Cosgrove DM. Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg
24. Grundmann R, Meyer H. The significance of colloid osmotic pressure measurement after crystalloid and colloid infusions. Intens Care Med
25. Goodwin CW, Dorethy J, Lam V, Pruitt Jr BA. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury. Ann Surg
26. Moggio RA, Rha CC, Somberg ED, Praeger PI, Pooley RW, Reed GE. Hemodynamic comparison of albumin and hydroxyethyl starch in postoperative cardiac surgery
patients. Crit Care Med
27. Rackow EC, Falk JL, Fein IA, et al.
Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med
28. Saunders CR, Carlisle L, Bick RL. Hydroxyethyl starch versus albumin in cardiopulmonary bypass prime solutions. Ann Thorac Surg
29. Kirklin JK, Lell WA, Kouchoukos NT. Hydroxyethyl starch versus albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization. Ann Thorac Surg
30. Metildi LA, Shackford SR, Virgilio RW, Peters RM. Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency. Surg Gynecol Obstet
31. Gallagher JD, Moore RA, Kerns D, et al.
Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesth Analg
32. Grundmann R, Heistermann S. Postoperative albumin infusion therapy based on colloid osmotic pressure. A prospectively randomized trial. Arch Surg
33. Nielsen OM, Engell HC. Extracellular fluid volume and distribution in relation to changes in plasma colloid osmotic pressure after major surgery
. A randomized study. Acta Chir Scand
34. Sade RM, Stroud MR, Crawford Jr FA, Kratz JM, Dearing JP, Bartles DM. A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg
35. Boldt J, von Bormann B, Kling D, Borner U, Mulch J, Hempelmann G. Volume replacement with a new hydroxyethyl starch preparation (3 percent HES 200/0.5) in heart surgery
. Infusionsther Klin Ernahr
36. Grundmann R, von Lehndorff C. Indications for postoperative human albumin therapy in the intensive care unit - a prospective randomized study. Langenbecks Arch Chir
37. Dawidson I, Berglin E, Brynger H, Reisch J. Intravascular volumes and colloid dynamics in relation to fluid management in living related kidney donors and recipients. Crit Care Med
38. Lumb PD. A comparison between 25% albumin and 6% hydroxyethyl starch solutions on lung water accumulation during and immediately after cardiopulmonary bypass. Ann Surg
39. Brown RO, Bradley JE, Bekemeyer WB, Luther RW. Effect of albumin supplementation during parenteral nutrition on hospital morbidity. Crit Care Med
40. Falk JL, Rackow EC, Astiz ME, Weil MH. Effects of hetastarch and albumin on coagulation in patients with septic shock. J Clin Pharmacol
41. Gines P, Tito L, Arroyo V, et al.
Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology
42. London MJ, Ho JS, Triedman JK, et al.
A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg
43. Marelli D, Paul A, Samson R, Edgell D, Angood P, Chiu RC. Does the addition of albumin to the prime solution in cardiopulmonary bypass affect clinical outcome? A prospective randomized study. J Thorac Cardiovasc Surg
44. McGrath LB, Gonzalez-Lavin L, Neary MJ. Comparison of dextran 40 with albumin and Ringer's lactate as components of perfusion prime for cardiopulmonary bypass in patients undergoing myocardial revascularization. Perfusion
45. Nielsen OM, Thunedborg P, Jorgensen K. Albumin administration and acute phase proteins in abdominal vascular surgery
. A randomised study. Dan Med Bull 1989; 36:
46. Rackow EC, Mecher C, Astiz ME, Griffel M, Falk JL, Weil MH. Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med
47. Bonser RS, Dave JR, Davies ET, et al.
Reduction of complement activation during bypass by prime manipulation. Ann Thorac Surg
48. Foley EF, Borlase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. A prospective, randomized trial. Arch Surg
49. Planas R, Ginés P, Arroyo V, et al.
Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis. Results of a randomized study. Gastroenterology
50. Prien T, Backhaus N, Pelster F, Pircher W, Bunte H, Lawin P. Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery
. J Clin Anesth
51. Adam R, Astarcioglu I, Castaing D, Bismuth H. Ringer's lactate vs serum albumin
as a flush solution for UW preserved liver grafts: results of a prospective randomized study. Transplant Proc
52. Himpe D, Van Cauwelaert P, Neels H, et al.
Priming solutions for cardiopulmonary bypass: comparison of three colloids. J Cardiothorac Vasc Anesth
53. Hoeft A, Korb H, Mehlhorn U, Stephan H, Sonntag H. Priming of cardiopulmonary bypass with human albumin or Ringer lactate: effect on colloid osmotic pressure and extravascular lung water. Br J Anaesth
54. Salerno F, Badalamenti S, Lorenzano E, Moser P, Incerti P. Randomized comparative study of hemaccel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology
55. Boldt J, Zickmann B, Ballesteros BM, Stertmann F, Hempelmann G. Influence of five different priming solutions on platelet function in patients undergoing cardiac surgery
. Anesth Analg
56. Fassio E, Terg R, Landeira G, et al.
Paracentesis with Dextran 70 vs. paracentesis with albumin in cirrhosis with tense ascites. Results of a randomized study. J Hepatol
57. Goslinga H, Eijzenbach V, Heuvelmans JH, et al.
Customtailored hemodilution with albumin and crystalloids in acute ischemic stroke. Stroke
58. Kanarek KS, Williams PR, Blair C. Concurrent administration of albumin with total parenteral nutrition in sick newborn infants. J Parenter Enteral Nutr
59. London MJ, Franks M, Verrier ED, Merrick SH, Levin J, Mangano DT. The safety and efficacy of ten percent pentastarch as a cardiopulmonary bypass priming solution. A randomized clinical trial. J Thorac Cardiovasc Surg
60. Wojtysiak SL, Brown RO, Roberson D, Powers DA, Kudsk KA. Effect of hypoalbuminemia and parenteral nutrition on free water excretion and electrolyte-free water resorption. Crit Care Med
61. Boldt J, Knothe C, Zickmann B, Andres P, Dapper F, Hempelmann G. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg
62. Boldt J, Knothe C, Schindler E, Hammermann H, Dapper F, Hempelmann G. Volume replacement with hydroxyethyl starch solution in children. Br J Anaesth
63. Garcia-Compeán D, Zacarias Villarreal J, Bahena Cuevas H, et al.
Total therapeutic paracentesis (TTP) with and without intravenous albumin in the treatment of cirrhotic tense ascites: a randomized controlled trial. Liver
64. Greenough A, Emery E, Hird MF, Gamsu HR. Randomised controlled trial of albumin infusion in ill preterm infants. Eur J Pediatr
65. Videm V, Fosse E, Svennevig JL. Platelet preservation during coronary bypass surgery
with bubble and membrane oxygenators: effect of albumin priming. Perfusion
66. Woods MS, Kelley H. Oncotic pressure, albumin and ileus: the effect of albumin replacement on postoperative ileus. Am Surg
67. Golub R, Sorrento Jr JJ, Cantu Jr R, Nierman DM, Moideen A, Stein HD. Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study. Crit Care Med
68. Mastroianni L, Low HB, Rollman J, Wagle M, Bleske B, Chow MS. A comparison of 10% pentastarch and 5% albumin in patients undergoing open-heart surgery
. J Clin Pharmacol
69. Tomita H, Ito U, Tone O, Masaoka H, Tominaga B. High colloid oncotic therapy for contusional brain edema. Acta Neurochir Suppl (Wien)
70. Greenhalgh DG, Housinger TA, Kagan RJ, et al.
Maintenance of serum albumin
levels in pediatric burn patients: a prospective, randomized trial. J Trauma
67-73; discussion 73-74.
71. Jenkins IR, Curtis AP. The combination of mannitol and albumin in the priming solution reduces positive intraoperative fluid balance during cardiopulmonary bypass. Perfusion
72. Luca A, Garcia-Pagán JC, Bosch J, et al.
Beneficial effects of intravenous albumin infusion on the hemodynamic and humoral changes after total paracentesis. Hepatology
73. Tølløfsrud S, Svennevig JL, Breivik H, et al.
Fluid balance and pulmonary functions during and after coronary artery bypass surgery
: Ringer's acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiol Scand
74. Brutocao D, Bratton SL, Thomas JR, Schrader PF, Coles PG, Lynn AM. Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass. J Cardiothorac Vasc Anesth
75. Gines A, Fernandez-Esparrach G, Monescillo A, et al.
Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology
76. Wahba A, Sendtner E, Birnbaum DE. Fluid resuscitation with Haemaccel vs. human albumin following coronary artery bypass grafting. Thorac Cardiovasc Surg
77. Buhre W, Hoeft A, Schorn B, Weyland A, Scholz M, Sonntag H. Acute affect of mitral calve replacement on extravascular lung water in patients receiving colloid or crystalloid priming of cardiopulmonary bypass. Br J Anaesth
78. Hondebrink Y, Jeekel L, Nijhuis JO, Woittiez AJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Intensive Care Med
79. Woittiez AJ, van Baal JG. Increased risk of death in critically ill patients after treatment with human albumin? Ned Tijdschr Geneeskd
80. Rubin H, Carlson S, DeMeo M, Ganger D, Craig RM. Randomized, double-blind study of intravenous human albumin in hypoalbuminemic patients receiving total parenteral nutrition. Crit Care Med
81. Saxena N, Chauhan S, Ramesh GS. A comparison of hetastarch, albumin and Ringer lactate for volume replacement in coronary artery bypass surgery
. J Anaesth Clin Pharmacol
82. Tigchelaar I, Gallandat Huet RC, Korsten J, Boonstra PW, van Oeveren W. Hemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass. Eur J Cardiothorac Surg
83. Tigchelaar I, Gallandat Huet RC, Boonstra PW, van Oeveren W. Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients. Perfusion
84. Altman C, Bernard B, Roulot D, Vitte RL, Ink O. Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis. Eur J Gastroenterol Hepatol
85. Gentilini P, Casini-Raggi V, Di Fiore G, et al.
Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol
86. Sort P, Navasa M, Arroyo V, et al.
Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med
87. Lennihan L, Mayer SA, Fink ME, et al.
Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke
88. Gurkan F, Haspolat K, Yaramis A, Ece A. Beneficial effect of human albumin on neonatal cerebral edema. Am J Ther
89. Petroni KC, Green R, Birmingham S. Hextend® is a safe alternative to 5% human albumin for patients undergoing elective cardiac surgery
90. Lucas CE, Weaver D, Higgins RF, Ledgerwood AM, Johnson SD, Bouwman DL. Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function. J Trauma
91. Smith CA, Phillips KG, Roth RO. Effects and fate of human serum albumin
administered intravenously and orally to premature infants. J Clin Invest
92. Vincent J-L, Dubois M-J, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness - is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg
93. Rackow EC, Fein IA, Leppo J. Colloid osmotic pressure as a prognostic indicator of pulmonary edema and mortality in the critically ill. Chest
94. Rackow EC, Fein IA, Siegel J. The relationship of the colloid osmotic-pulmonary artery wedge pressure gradient to pulmonary edema and mortality in critically ill patients. Chest
95. Belisle S, Hardy JF. Hemorrhage and the use of blood products after adult cardiac operations: myths and realities. Ann Thorac Surg
96. Unsworth-White MJ, Herriot A, Valencia O, et al.
Resternotomy for bleeding after cardiac operation: a marker for increased morbidity and mortality. Ann Thorac Surg
97. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg
98. Gravlee GP, Arora S, Lavender SW, et al.
Predictive value of blood clotting tests in cardiac surgical patients. Ann Thorac Surg
99. Wilkes MM, Navickis RJ, Sibbald WJ. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery
: a meta-analysis of postoperative bleeding. Ann Thorac Surg
527-533; discussion 534.
100. Herwaldt LA, Swartzendruber SK, Edmond MB, et al.
The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol
101. Vincent JL. Fluid management: the pharmacoeconomic dimension. Crit Care
2000; 4 (Suppl 2):
102. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin
level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg
103. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med
104. Toole JG. Use of hetastarch for volume expansion. J Neurosurg
105. Trumble ER, Muizelaar JP, Myseros JS, Choi SC, Warren BB. Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg
106. Hypervolemic hemodilution treatment of acute stroke. Results of a randomized multicenter trial using pentastarch. The Hemodilution in Stroke Study Group. Stroke
107. Mast H, Marx P. Neurological deterioration under isovolemic hemodilution with hydroxyethyl starch in acute cerebral ischemia. Stroke
108. de Jonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med
109. Zoellner H, Hou JY, Lovery M, et al.
Inhibition of microvascular endothelial apoptosis in tissue explants by serum albumin
. Microvasc Res
110. Rhee P, Wang D, Ruff P, et al.
Human neutrophil activation and increased adhesion by various resuscitation fluids. Crit Care Med
111. Kamada T, McMillan DE, Sternlieb JJ, Bjork VO, Otsuji S. Albumin prevents erythrocyte crenation in patients undergoing extracorporeal circulation. Scand J Thorac Cardiovasc Surg
112. Fliser D, Zurbruggen I, Mutschler E, et al.
Coadministration of albumin and furosemide in patients with the nephrotic syndrome. Kidney Int
113. Lindow J, Wijdicks EF. Phenytoin toxicity associated with hypoalbuminemia in critically ill patients. Chest
114. Bergman I, Steeves M, Burckart G, Thompson A. Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. J Pediatr