INDICATIONS AND PLACE OF ALBUMIN IN POSTO PERATIVE FLUID RESUSCITATION

Prospective clinical trials comparing human albumin to other plasma vo lume expanders during the three first postoperative days in adult pati ents were analysed. Fifteen studies were selected. Nine of them concer ned the evaluation during the immediate postoperative period, after ca rdiac surgery with cardiopulmonary bypass (CPB). Only one trial referr ed to hyperoncotic albumin and therefore did not allow to produce reco mmendations. However, a priori hyperoncotic albumin should not be used for plasma volume expansion. All other studies compared isooncotic al bumin to crystalloid or hydroxyethylstarches (HES). It is concluded th at albumin can be recommended neither after vascular (aortic abdominal surgery), nor abdominal surgery and can be replaced by Ringer lactate solution in a volume 1.5 to 2 times higher than with albumin. After c ardiac surgery, mainly uncomplicated coronary artery bypass graft or v alve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume, The place of isooncotic albumin for fluid resuscitation in case of blood loss ex ceeding 50% of blood volume cannot be specified.