Aims & Objectives:
To study feasibility and safety of albumin diuresis and to compare outcomes of treatment with intravenous 20% albumin and furosemide vs placebo and furosemide in critically ill mechanically ventilated hypoalbuminemic children with fluid overload.
Forty-four mechanically ventilated children aged 2months–12years in post-resuscitation phase with >10%fluid-overload and serum albumin <2.5g/dL were enrolled over 12months. Children with hemodynamic instability, chronic conditions affecting fluid/albumin status and prior adverse reactions to study drugs were excluded. In intervention arm, subjects received 1g/kg 20%albumin (5ml/kg) single dose over 6hours with furosemide infusion for 48 hours, subjects in placebo arm received 5ml/kg 0.9%sodium chloride with furosemide infusion.
Median age, fluid balance and serum albumin at enrollment were 2.8years, 132ml/kg and 2.1g/dL respectively. Median rise in serum albumin at 24 hours was 0.8g/dL in albumin group and -0.1g/dL in placebo group (p<0.001). Primary outcome, 28-day ventilation free days, didnot differ significantly between groups (25 vs 24 days, p=0.24). Time to liberation from mechanical ventilation (62 vs 72 hours, p=0.34) and time to extubation (66 vs 76 hours, p=0.42) were shorter in albumin group though not statistically significant. Secondary outcomes like all-cause 28-day mortality, post-enrolment PICU stay and hospital stay were similar. No significant difference was noted in lung compliance and oxygenation index. Incidence of hemodynamic instability post-enrolment was higher in placebo group though not statistically significant (18% vs 5%, p=0.17).
Albumin diuresis, though safe, didnot demonstrate clear benefit in fluid-overloaded, hypoalbuminemic, mechanically-ventilated, critically-ill children. We advocate larger trial targeting higher serum albumin to further determine its utility.