PLACE OF ALBUMIN IN MANAGEMENT OF PULMONA RY-EDEMA AND SEPTIC SHOCK, APART FROM PLASMA-VOLUME EXPANSION

Patients with septic shock deserve a global approach. Intravascular vo lume loading is part of the treatment. However several questions remai n open: what are the respective contributions of volume expansion and vase-active drugs in the restoration of blood pressure and increase of cardiac output, which volumes and type of solutions should be used, w hich pulmonary capillary wedge pressure should be targetted, and which evaluation criteria are the most appropriate? Few experimental and cl inical studies provide evidence of a superiority of colloids over crys talloids, although none of them has documented a reduction of mortalit y, lenght of stay in ICU or duration of mechanical ventilation. There are no data support-ing a superiority of albumin over artifical colloi ds, which are also much cheaper. Moreover, hydroxyethylstarch could ha ve promising properties in case of increased capillary permeability. I n summary and in agreement with the North American consensus conferenc e, albumin should not be recommended for the treatment of septic shock , whether associated with non cardiogenic pulmonary oedema or not.