Impaired Pulmonary Function after Albumin Resuscitation from Shock

Abstract

The effects of albumin supplementation on pulmonary function were studied in 94 injured patients of whom 46 received albumin. The 94 patients received an average of 14.5 transfusions, 9.2 L crystalloid, and 0.9 L plasma in the emergency room and operating room; 46 patients received an average of 31 gm albumin during operation and 150 gm/day for 5 days. Blood pressure (BP), pulse, CVP, wedge pressure (PWP), red cell (RBCV), and plasma volumes (PV), total serum proteins (TSP), serum albumin (SA), cardiac output (CO), the per cent inspired oxygen/arterial O₂ tension (FIO₂/pO₂), and the per cent of physiologic shunting in the lungs (p shunt) were noted serially following operation; only the first study on each patient was used for statistical correlations between the two groups. Albumin supplementation significantly (p = 2/ pO₂ ratio and the p shunt were significantly deranged in albumin patients. The FIO₂/pO₂ ratio averaged 0.62 ± 0.6 in the albumin patients, and 0.33 ± 0.1 in the nonalbumin-treated patients; the p shunt averaged 29 and 19%, respectively. The albumin patients required ventilatory support for an average of 7.7 days versus 2.9 days in the nonalbumin patients (p = <0.05). These detrimental effects of albumin on pulmonary function may be due to decreased saline diuresis, increased interstitial pulmonary water due to ‘trapped’ albumin, impaired left ventricular function or some combination of the above. Regardless of mechanism, supplemental albumin resuscitation for hypovolemic shock is contraindicated.