Rachael A.F. Cusack , Alejandro Rodríguez , Ben Cantan , Alexis Garduno , Elizabeth Connolly , Gabor Zilahi , John Davis Coakley , Ignacio Martin-Loeches
{"title":"Microcirculation properties of 20 % albumin in sepsis; a randomised controlled trial","authors":"Rachael A.F. Cusack , Alejandro Rodríguez , Ben Cantan , Alexis Garduno , Elizabeth Connolly , Gabor Zilahi , John Davis Coakley , Ignacio Martin-Loeches","doi":"10.1016/j.jcrc.2025.155039","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients <em>(</em><span><span><em>ClinicalTrials.gov</em></span><svg><path></path></svg></span> <em>ID:</em> <span><span><em>NCT05357339</em></span><svg><path></path></svg></span><em>).</em></div></div><div><h3>Methods</h3><div>We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin <em>n</em> = 52, Control <em>n</em> = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis.</div></div><div><h3>Results</h3><div>The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18–86). The mean APACHE score was 28 (range: 7–45), and the mean SOFA score was 9.4 (range: 1–17). No significant differences in APACHE (26.24 vs. 29.4, <em>p</em> = 0.069) or SOFA (9.08 vs. 9.78, <em>p</em> = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (<em>p</em> < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155039"},"PeriodicalIF":3.2000,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of critical care","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0883944125000267","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients (ClinicalTrials.govID:NCT05357339).
Methods
We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin n = 52, Control n = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis.
Results
The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18–86). The mean APACHE score was 28 (range: 7–45), and the mean SOFA score was 9.4 (range: 1–17). No significant differences in APACHE (26.24 vs. 29.4, p = 0.069) or SOFA (9.08 vs. 9.78, p = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (p < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups.
Conclusion
This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients.
期刊介绍:
The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice.
The Journal will include articles which discuss:
All aspects of health services research in critical care
System based practice in anesthesiology, perioperative and critical care medicine
The interface between anesthesiology, critical care medicine and pain
Integrating intraoperative management in preparation for postoperative critical care management and recovery
Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients
The team approach in the OR and ICU
System-based research
Medical ethics
Technology in medicine
Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education
Residency Education.